Accessing health care can be challenging, but Polk County experts shared some hopeful news Tuesday evening about how the medical landscape in our area is changing and advice for residents who might be struggling to get their needs met.
It was part of a community health care forum hosted by LkldNow and Lakeland Vision in the auditorium of Lakeland Regional Health’s Hollis Cancer Center.
Panelists were Dr. Daniel Haight, vice president of community health and medical director of infection prevention at Lakeland Regional Health Medical Center; Joy Johnson, Polk County Health and Human Services administrator; Jason Hirsbrunner, CEO of Watson Clinic; and Ann Claussen, CEO of Central Florida Health Care.
Lakeland Volunteers in Medicine President and CEO Alice Koehler moderated.
Watch the forum:
All four panelists agreed that access to health care, including mental health counseling, is a top concern for many Polk County residents.
“Right now, folks are really busy, they’re under a lot of stress and just finding time for their own health care,” Haight said. “So that’s one of the access issues. Second is getting that access — the transportation, the cost, just navigating and also just finding the time to take care of your own health … There could even be a fear or trust issue.”
Johnson, who oversees and coordinates indigent health care in Polk County, agreed.
“I think overall — even health care aside — the vast explosion of the population growth in Polk County has created a number of challenges across the board,” Johnson said. “When it comes to health care, though, it’s an ever-evolving, changing environment. Because you’ve got a lot of things coming down from the state, coming down from the federal government … We’re constantly trying to keep our fingers on the pulse of those policy level changes that will impact the way we fund our local health care safety net here in Polk County.
Help for those who are uninsured
Claussen said the 2020 Census showed that there were nearly 50,000 uninsured adults in Polk County who live below 200% of the federal poverty level, and the number likely has grown since then.
One solution to help residents without insurance gain access to health care might be the Polk HealthCare Plan.
In September, the Polk County Citizens Healthcare Oversight Committee approved relaxing income requirements for participation in the county plan. Previously, for example, to be eligible for PHCP, a family of three could earn no more than $50,400 annually. Now they can earn up to $60,000 per year and still qualify.
Officials said the change is, in part, a reflection of the minimum wage increase that went into affect on September 30.
“Families may make more money now due to higher pay but, thanks to the escalating cost of living, they still may not be able to afford health care,” they said in a press release.
Johnson said for those living at or below the poverty level, “health care is competing with their other basic needs … They’re paying more just to live and survive. They truly could benefit to have access to health care.”
Johnson said that if Polk County does not get out ahead of the population growth, particularly with educating residents about the care available, it could cost the community more in the long run.
“If we continue to stay stagnant, we will not be able to meet those changing needs,” Johnson said.
The panelists were frustrated that Florida is one of 10 states that has not expanded Medicaid coverage under the Affordable Care Act to help those at or below the poverty level. But Johnson said, thanks to Polk County’s half-cent sales tax, the community has been able to expand what it offers. The Polk HealthCare Plan offers primary care, including:
- Annual physical exams and preventive screenings.
- Sick visits or checkups as needed.
- Prescriptions.
- Immunizations (shots).
- Referrals to specialists.
The plan also includes behavioral health care, urgent care and emergency care.
The plan is not insurance and members do not pay annual deductibles, monthly fees, enrollment fees or submit claim forms. Members pay small co-pays for doctor visits or filled prescriptions. Johnson said it also provides specialty care, including durable medical equipment and joint replacement surgeries, things that were considered very high-cost in the past.
“Polk is very fortunate because we’ve got a whole lot more than our surrounding counties do,” Johnson said.
But, she acknowledged, “It’s very confusing when you’re covered for a short while, then you‘re not covered, when there’s this program and now it’s not available,” she said. “We understand it can be very challenging and we have a lot of work to do still.”
She added that they have expanded health care from outside the county clinics.
“It’s not just a clinic setting, it’s private practice. They get to choose their medical home; we have negotiated rates with our providers,” she said. “We’ve added benefits and services to the program.”
To qualify for the PHCP, a person must:
- Be a full-time resident of Polk County.
- Have no health insurance coverage or medical coverage.
- Have no or low-household income.
- Provide a social security number.
- Provide a valid Florida issued driver’s license or ID card.
- And provide two proofs of residency and proof of income.
The county also has employees called navigators in their clinics and also in local hospitals to make sure that people know the Polk HealthCare plan is available. A new, more easily navigable website is coming soon to help patients.
Claussen said that because of the half-cent sales tax, Polk County has been able to add several health centers and hire specialty care physicians, including an endocrinologist, rheumatologist, podiatrist and an optometrist.
The local impact of new state laws
Several panelists thanked Florida Sen. Colleen Burton, R-Lakeland, for her work on the Live Healthy initiative, a package of multiple bills that Gov. Ron DeSantis signed into law last week.
The legislation offers new training opportunities, improves access to health care services in rural areas, and promotes technological advancements. The initiative also creates a new category of teaching hospitals dedicated to advancing behavioral health care through research, collaboration with colleges and universities, and partnerships with state agencies to address acute behavioral health care needs.
Lakeland Regional Health recently became a teaching hospital with the addition of a graduate medical education program, and Haight said the LRH system has made great strides in hiring specialists and filling gaps locally so people don’t have to travel to Tampa or Orlando for care.
However, Haight said two big things the Lakeland area still lacks are a burn unit and transplant center. Those are among the hospital’s goals.
Koehler asked the panelists how they’re handling a new state requirement to ask patients about their immigration status.
“We want all patients to feel safe in obtaining health care,” Haight said. “Along with all the other things we have to ask and information that’s gathered, this question is asked and the answer can be: ‘I decline to answer.’”
Claussen said because Central Florida Health Care is not a hospital, its requirements are different.
“We do see a lot of the migrant population,” she said. “We don’t have to ask that question and we can just treat every patient that comes through the door.”
Less red tape, more preventative care
The panelists emphasized that preventative care is critical and it’s important for patients to advocate for themselves, but they acknowledged that accessing care can be difficult.
“The delivery of health care — the ability to access health care — is so convoluted and so full of red tape and so difficult,” Hirsbrunner said.
“We have got to be more efficient … I mean, my God, we still rely on faxes. I hate faxes.”
Jason Hirsbrunner, CEO of Watson Clinic
He said there are two fundamental parts of health care: the transaction and the relationship. The transaction part includes setting appointments, making referrals, approving medication refills.
“The relationship is, ‘I’m scared and I have questions’ and that sort of thing,” Hirsbrunner said. “So much of our time on the phones is on that transaction. We have got to be more efficient when it comes to the transaction. So many industries have done that and we’ve been reticent to do it. I mean, my God, we still rely on faxes. I hate faxes.”
He said over the past two years of his tenure, Watson Clinic has focused on reducing red tape so patients can have easier access to health care providers. But he added, “Like any relationship, it takes two. The number one tip is be a part of that relationship, be involved in that relationship. Ask those questions and really help steer your own (care). Be an advocate for yourself.”
Haight urged people to engage in their patient portal and the portals of family members or friends, with their permission, and to ask three questions of providers when discussing results:
- What is my main problem?
- What do I need to do about it?
- And why is this important to me?
“Ask those questions and make sure you’re satisfied with the answers,” he said. “If not, go elsewhere.”
Hirsbrunner said Watson Clinic is using new educational tools to try to get creative “to make sure there are no barriers” and to “removing the red tape” to receive care.
He added that they’re trying to work with people who are using Watson Clinic’s urgent care system as their primary care by providing them with either same-day or next-day appointments to a primary care doctor.
He said the organization’s hope is that when patients meet that provider, they will establish a relationship with them and want to return to them, rather than an urgent care facility. Then patient and doctor can work together on preventative care going forward, which is easier and far less expensive to treat.
Johnson and Haight encouraged people not to skip routine preventative checkups, because preventative care is much cheaper than treating a full-blown issue.
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Create your own user feedback survey‘Mental Health First Aid’ and behavioral health care
Behavioral health care is another top priority for area residents and health care officials. A year-long study by Polk Vision released in 2021 shows one in seven of your friends, neighbors and co-workers live with depression or are otherwise at risk for behavioral health challenges.
But the Polk Vision report also shows that there is a critical shortage of mental health counselors in Polk County.
The ratio of the population to mental health providers in Polk is 1,190 to 1. Florida is 670 to 1. The national benchmark is 310 to 1.
Multiple agencies recently joined forces with the Polk County Sheriff’s Office to ensure inmates and former inmates would receive care while incarcerated and when they are released. The effort will allow the agencies, with patient permission, to collaborate on patient care. In the past, the various agencies and care facilities didn’t share information.
Last year, Lakeland Regional Health Medical Center opened the Harrell Family Center for Wellness, a 96-bed mental health facility.
Johnson said the county recently hired four paramedics to help in that transitional effort, bringing their team up to five to help people who might not have a support network of family or friends.
Haight said several local organizations including Lakeland Regional and Peace River Center are already training people to help with “Mental Health First Aid” classes. They are targeting teachers, coaches and workers at various companies.
There is an upcoming “Youth Mental Health First Aid” training at Bonnet Springs Park on April 29 from 9 a.m. to 3 p.m., offered through the Carol Jenkins Barnett United Way Children’s Resource Center. Participants must be at least 18 years old. A light lunch will be provided.
“You help to recognize who’s in trouble by not being judgmental, by asking the right questions, by just being there” Haight said.
According to the thisismybrave.org website, five signs that may mean someone is in emotional pain and might need help include: personality changes, agitation, withdrawal, poor self-care and hopelessness.
Haight encourages people to ask about these issues by simply saying, “Hey, I’ve noticed things are little different. Are you okay?” and offer to help them find a psychologist, psychiatrist, social worker or counselor. He said often people will turn down offers of help, but he said that can be met with a statement: “If you ever need me, let me know.”
One thing he said they train people to look for are the signs that people are considering suicide. Those signs include:
- Talking about wanting to die.
- Discussing feelings of great guilt or shame.
- Saying they’re a burden to others.
- Having feelings of emptiness, hopelessness, being trapped, having no reason to live, unbearable emotional or physical pain.
- Being extremely sad, more anxious, agitated, or full of rage.
- Making a plan or researching ways to die.
- Withdrawing from friends, saying goodbye, giving away important items, or making a will.
- Taking dangerous risks such as driving extremely fast.
- Displaying extreme mood swings.
- Eating or sleeping more or less.
- And/or using drugs or alcohol more often.
If you are struggling with mental health
Authorities remind those struggling with mental health issues to call or text 988, the national mental health hotline. It is free, confidential and available 24 hours a day, seven days a week. For more information, visit https://988lifeline.org/
Johnson said Polk County has secured grants to begin peer training for teens.
“The teen population they generally learn from their peers,.” Johnson said. “So what better opportunity than to offer some training to get more of us prepared and equipped with the tools to help those who are going through a lot of life’s challenges.”
She said the county is working with local high schools, colleges and universities to encourage students to go into the mental health care field. And, she said, they are using their position in the community to lobby lawmakers to get grant funding and make policy changes.
Hirsbrunner and said Watson Clinic has multiple openings for both psychiatrists, who can prescribe medication, and psychologists.
Hirsbrunner said they are trying to incorporate mental health professionals into their clinics’ offices to have a “warm handoff” for patients, so doctors can say, “Hey, I’ve really got somebody I want you to talk to” and the counselor can then at least introduce themselves to the patient.
Claussen said Central Florida Health Care used to refer mental health counseling out to private practices, but now they provide that level of care.
“We have a team in our Winter Haven office that sees people and they also have a practitioner in there,” Claussen said.
Insurance woes
One person asked if insurance companies were dictating health care.
Hirsbrunner immediately answered yes, which prompted laughter from the audience at his honesty. He added that there are steps insurance companies require physicians to endure, even when the physicians know the answer they’re trying to get to, which increases the cost.
“It boggles my mind when I have a physician that says, ‘Hey I think this patient should have X,’ and then the insurance company says no and then there’s an escalation process that takes days and, at the end of the day, the final escalation is having the insurance doctor talk to the doctor who said they needed it and say, ‘Why do you think they need it?’ Because it’s my patient and that’s what I think,” Hirsbrunner said. “It’s an utter waste of time, it’s an utter waste of resources.”
Haight said Lakeland Regional’s transition to an academic medical center might help the situation.
“When you do get that frustrating phone call, it becomes quite simple when the physician that’s advocating for their patient knows the medicine, knows the science,” Haight said. “Yes, it is very frustrating and we have to really prepare and get ready to go battle and advocate for our patients.”
Considerations with older patients
Care for the elderly was also a topic of a concern.
Haight said it is so important that he Lakeland Regional is recruiting geriatric physicians and he is trying to become more certified in geriatric care. Lakeland Regional recently became accredited as a geriatric emergency department.
He said caregivers and health care workers have to be on the lookout for the three Ds: delirium, dementia and severe depression. These can be exacerbated by dehydration.
“Caring for someone that’s older — we have to understand that transition process, that once the Emergency Room has done its job, how do you transition to a room,” Haight said. “If I fall and have a trauma, it’s going to be different than someone who is 75- 80-years-old. You can’t just hop up on that X-ray table. You need that extra care. The skin can tear easily … We have to raise that awareness.”
He added that caregivers in nursing home facilities also need to provide trauma-informed care and ask patients about any traumas in their past because something that happened decades ago can affect them today.
‘Dental deserts’ and children’s teeth
A person in the audience also asked about dental health care for indigent patients.
Claussen said when she started in affordable health care, there were only a few dental clinics.
“We actually had our dentist cleaning teeth,” she said. “We now have 11 dental clinics staffed with dentists, hygienists and dental assistants.”
She said they were seeing, 3-, 4- and 5-year-olds who had never owned a toothbrush. They have been advocating for several years to have “dental therapists,” which the legislature has considered for several years.
“I think there’s a lot of conversation and a lot of misunderstanding from perhaps the private dental world of what that person is going to do,” Claussen said.
According to the American Children’s Campaign, more than 140 organizations and individuals are advocating for the passage of Florida HB 1173 and SB 1254, which were introduced by Floridians for Dental Access, American Children’s Campaign, and Florida Dental Hygienists’ Association.
The legislation would license “mid-level oral health providers” to increase dental access and improve the overall health of Floridians. They would be licensed, but not hold a medical dental degree.
“Oral health in Florida is among the worst in the nation,” an American Children’s Campaign press release stated. “Florida leads the nation in the number of individuals living in Dental Health Professional Shortage Areas. Nearly 6 million Floridians live in these dental deserts, causing them to live in pain, miss work or school or visit the emergency room for preventable dental conditions. Florida hospitals billed over $550 million in 2021 for emergency room and hospital admissions related to non-traumatic dental conditions.”
Dr. Frank Catalanotto, president of Floridians for Dental Access, said “hospitals are the most expensive and least equipped place to treat preventable dental conditions. All they can do is provide temporary pain relief. The pain returns when the antibiotics wear off. And Florida taxpayers are largely picking up the tab.”
Haight said when he was the director of the Polk County Health Department in 1996, of all the health departments, “Polk County was the number one provider of dentures in the state of Florida. And no children were seen.”
He explained that when children lose their baby teeth prematurely, they will grow up speaking differently than their peers, including covering their mouths when they speak even after their adult teeth grow in.
Johnson said the county provides funding to LVIM, Central Florida Health Care, the Department of Health and the Travis Vocational College’s dental assistants’ program to help care for patients.
Save the date
LkldNow’s next community forum will be a candid conversation about mental health services. It is scheduled for lunchtime on May 14.
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