AdventHealth Executive Outlines Looming Healthcare Crisis and Innovations to Solve Florida Medical Shortages

There is a lot of “gloom and doom” in Florida’s healthcare system and more doom on the horizon, from spiraling costs to an enormous shortage in nurses and physicians, Rob Deininger told a sold-out crowd at Flagler Tiger Bay Club Tuesday. But there are also a lot of bracing innovations, some of them already in effect–from telemedicine to AI to at-home care–that may at least alleviate cost pressures, boost access to care and improve outcomes. 

Deininger is president and chief executive officer of AdventHealth’s East Florida Division, which oversees facilities in Flagler, Volusia and Lake counties. His talk focused on “Trends in Healthcare: How Innovation, Access, and Economics are Shaping the Next Decade.” AdventHealth started as Florida Hospital in Orlando in 1908. It is now a network of 33 hospitals in the state, two of them in Palm Coast, plus urgent care, rehab and ambulatory facilities, with some 100 doctors in Palm Coast. 

Despite the odd, indecorous and entirely un-Tiger-like reference by a club member to “fatties” in reference to the county’s students–some of whom were in attendance–the audience of business and nonprofit leaders, politicians, judges and other professionals seemed genuinely engaged, if also dazed, by the scope of Deininger’s talk. 

“Regardless of where your political affiliation sits, everyone can pretty much agree that healthcare, as we interact with it today, is broken in some way or another,” Deininger said. “What we don’t seem to ever be able to agree on is how we’re going to fix that.” He was not proposing a fix. But he came close to providing a roadmap to a fix, once he was done surveying the broken parts. 

A commercial airline pilot for 13 years, Deininger joined AdventHealth in 2008, leading AdventHealth Orlando and guiding the organization through the pandemic as a “system incident commander.” That experience with crisis management probably explains the lucid pragmatism behind his analysis of what amounts to an entire system in crisis. 

Topping the broken category is cost. “That’s what drives a lot of that frustration, is the value proposition people see as the gap between it costs too much [and] we don’t get enough out of that,” Deininger said. In the last few years, states rather than the federal government have been attempting to fix that problem, “which on one hand is admirable, on the other hand is frustrating, because it means we’re going to do things 50 different ways,” he said. “But states are doing what they should be doing, which is putting pressure on the federal government by doing things locally to try and see if they work.”

For example: trying to eliminate surprise billing–that phenomenon that has you thinking you’ve paid your hospital bill only to subsequently receive a bill from the anesthesiologist, from the emergency physicians, and so on. The rationale behind it is driven by the reality of a marketplace that requires hospitals to treat everybody who walks in, whether they can pay or not. “What that leads us to do is to have to charge more effectively for the people who can pay, to offset the amount of people that don’t pay,” he said. “You hear that expressed as the cost of uncompensated care.”

It was a different way of saying that if you’re insured and you can pay, you will be charged more than you normally would be–if everyone paid–so your dollars can subsidize the care costs of those who can’t pay. Those costs are enormous. In Florida alone, costs generated by people who could not pay their bills rose from $3.1 billion to $3.6 billion in four years. (That’s $156 for every Floridian.) The expiration of healthcare subsidies, resulting from the refusal of the Trump administration to extend a Biden administration provision in the Affordable Care Act, will worsen the situation as more Floridians lose health insurance. 

Medicaid and Medicare, the government insurance programs for the poor and the elderly, play an outsized role in healthcare, with over 40 percent of births in Florida, for example, covered by Medicaid, and 60 percent of nursing home days covered by Medicare. “Florida’s elderly population is projected to increase by 2.4 million from 2020 to 2040,”  Deininger said. “Why do we care about that? Because populations 65 and older consume three to five times more health care than a population that’s under them.” 

Add to that the surging costs of drugs, the cost of cybersecurity–an increasing concern in healthcare–and the cost of contending with cyber attacks (one of them against a blood bank caused a sudden shortage of blood in Florida), plus the absence of caps on malpractice payouts (“We are number two in malpractice claims paid behind California, not the list you want to be behind California”), and the financial challenges for the industry and for patients become daunting. 

There are also challenges to the system that go beyond costs: there is a projected shortage of 60,000 nurses in Florida by 2035 despite improvements through partnerships with local universities (such partnerships involve AdventHealth Palm Coast and the University of North Florida and Daytona State College). The state also faces a projected shortage of 18,000 physicians. 

“We have to continue to invest in those strategies and make sure that we’re attracting the workforce of tomorrow,” Deininger said. “That’s an area that, if you were to ask any of the executives in healthcare across Florida, is continuing to be a significant concern for us, because our ability to retain and train and grow top physician talent has the potential to be one of our limiting factors for access.”

That’s the gloom and doom. There are also positive developments. 

One way to address the shortage of nurses and physicians and improve patient outcomes in many cases: “Hospital at home.” Between technology such as telemedicine and skilled care, between 30 to 40 percent of patients admitted to hospitals could instead be safely treated at home, where patients prefer to be anyway. “The payment model wasn’t there to make it attractive enough for people to really look at it,” Deininger said. “That has changed in the last couple of years, and you can see in Florida, 45 hospitals, including AdventHealth, have been approved by CMS to run hospital at home programs. I expect you’ll see that continue to be something we talk more about.” (CMS is the acronym for the Centers for Medicare and Medicaid Services.) 

Telemedicine will be particularly visible. “Most all healthcare systems in Florida, including AdventHealth, have a well developed telemedicine platform,” he said. “Most of us are doing that today because it’s the only way we’re getting access to some specialties. Neurologists, for example. If you get a stroke in a hospital today, more than likely, if you’re at a smaller hospital, you’re going to see a neurologist on a TV screen who’s going to diagnose you based on an image they’re seeing on their computer, and order TPA, stroke medication, effectively in the moment from a remote location, and it’s been game changing for the access to those kind of specialties and our ability to deliver care. You can expect to see virtual medicine, telemedicine, continue to be something that gets widely adopted over the next few years.”

Then there’s robotics and artificial intelligence, which Deininger said has “tremendous potential” in healthcare. AI is used in 70 applications at AdventHealth today, from radiology reports as means of doublechecking a radiologist’s analysis to prioritizing scans to listening to doctors’ visits to turn it into notes for the physician’s approval. “It means that the doctor doesn’t have to spend your entire visit typing on his or her computer, not looking at you, not paying as close attention to you, or it means that they don’t have to, at the end of their day, spend two or three hours at home at night finishing up all that documentation that they couldn’t get done during their 15 minute visits during the course of the day.”

He added: “AI is not intended to replace humans. It is intended to make us more efficient and allow our caregivers to focus on what they actually got into medicine for which is caring for people, not doing a ton of documentation.” 

Deininger speaks optimistically, he says, because he sees solutions in those innovations that may scale the healthcare system’s chronic problems, and in states experimenting. “The more states that come together with solutions, rather than just waiting for someone else to come up with solutions that will be good for all of us,” he said. 

“We are the most expensive health care system in the world,” he said. “We’re not always getting all those other buckets lined up, but we all want the same thing. So my optimism comes from recognizing that there is something we all have in common, regardless of whether you think you have the solution to fix it.” Pressuring state government, pressuring the federal government, innovating and taking advantage of technology, and for the public at large, staying aware and educated about the healthcare system and its challenges, can help address them. “I have incredible optimism about Florida and our ability to figure it out,” he said, “in part because of the people in this room who show up, who represent your business backgrounds, your government backgrounds, the more you know about this, the more I think you’re empowered to be able to help us fix it together.”