Arkansas continues to struggle with its emergency care environment but has made laudable improvements in Quality and Patient Safety and Disaster Preparedness over the past 5 years. Reversing the trend in its Medical Liability Environment, strengthening current systems for ensuring quality health care and patient safety, and improving Access to Emergency Care will help the state face its formidable public health and injury problems.
Arkansas moved up 12 places in Disaster Preparedness, largely due to its enhanced hospital capacity for responding to a disaster. The state has one of the highest per capita number of ICU beds (396.0 per 1 million people), as well as a high bed surge capacity (1,332.6 per 1 million). Since the previous Report Card, Arkansas has been accredited by the Emergency Management Accreditation Program and implemented liability protections for health care workers during a declared disaster.
Arkansas has also made improvements to its Quality and Patient Safety Environment. The state has or is working on a stroke system of care, as well as a percutaneous coronary intervention (PCI) network or ST-elevation myocardial infarction (STEMI) system of care, and has implemented destination policies to allow EMS to bypass local hospitals to take STEMI and stroke patients to hospital specialty centers. The state ranks fifth in the nation in the time that it takes to transfer a chest pain patient to another facility (50 minutes). Arkansas hospitals have demonstrated a commitment to quality improvement, with 77.7% collecting data on race/ethnicity and primary language and 51.5% having or planning to develop a diversity strategy.
While Arkansas received poor marks in Access to Emergency Care overall, it has seen a number of improvements related to its hospital capacity. In 2009, Arkansas was the only state in the nation with no Level I or II trauma centers; now the state has four certified trauma centers, greatly improving access to life-saving emergency care. The state has the third highest number of psychiatric care beds per capita (50.0 per 100,000 people), as well as a relatively high rate of staffed inpatient beds (377.9 per 100,000 people) and low hospital occupancy rate (57.9 per 100 staffed beds). As such, the state enjoys the 13th lowest emergency department (ED) wait time (223 minutes from ED arrival to ED departure for admitted patients).
Arkansas faces significant challenges in several areas. It continues to be one of the last states in terms of Public Health and Injury Prevention, with poor ratings on a wide range of indicators. Arkansas has one of the highest rates of traffic fatalities for drivers and passengers (17.9 per 100,000 people), as well as notably high rates of bicyclist fatalities (11.3 per 100,000 cyclists) and pedestrian fatalities (8.1 per 100,000 pedestrians). Arkansas fares poorly in indicators of chronic disease burden and risk. The state has one of the highest adult smoking rates (27.0%) and very high rates of obesity among adults (30.9%) and children (20.0%).
Arkansas suffers several notable workforce shortages, which greatly impede Access to Emergency Care. The state ranks among the bottom five for emergency physicians, orthopedists and hand surgery specialists, and plastic surgeons. The state also has the lowest per capita rate of physicians accepting Medicare (1.7 per 100 beneficiaries), and its Medicaid fee levels have remained stagnant since 2007.
Arkansas's Medical Liability Environment is mixed. On the positive side, the state has one of the lowest average medical liability insurance premiums for primary care physicians ($7,119) and specialists ($31,602). On the negative side, it has seen an increase in the average medical malpractice award payment; had its provisions for case certification declared unconstitutional; and has failed to enact many important liability reforms.
Arkansas's high rate of traffic-related fatalities points to a need for education and legislation related to traffic safety. The state should consider passing legislation to require motorcycle riders to wear a helmet and require that all car occupants use seat belts in all seats. Additionally, given the third highest rate of adults who currently smoke in the nation, public health officials in Arkansas should focus on passing smoke-free legislation for bars, restaurants, and worksites.
To help combat its workforce shortages and improve overall Access to Emergency Care, Arkansas should enact such medical liability reforms as a medical liability cap on non-economic damages, additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), pretrial screening panels, and a complete repeal of joint and several liability. Improving the Medical Liability Environment will help to ensure that the state can recruit and retain a health care workforce that matches the gains made in hospital capacity and specialty facilities.