The District of Columbia remains at the top of the pack, with one of the strongest emergency care environments in the nation, stellar overall Access to Emergency Care, and a strong commitment to Disaster Preparedness. While the District has improved the Quality and Patient Safety Environment, it continues to struggle with the worst Medical Liability Environment in the nation and excessive emergency department (ED) wait times.
The District has the top-ranked environment for Access to Emergency Care and is first in the nation for rates of many specialists, such as neurosurgeons; emergency physicians; and ear, nose, and throat specialists. The District has high rates of health insurance among adults and children, with only 4.3% of children and 9.3% of adults lacking health insurance. It also has the second highest per capita rate of physicians accepting Medicare (5.3 per 100 beneficiaries), as well as high Medicaid reimbursement rates for office visits, which realized the largest increase in the nation from 2007 to 2012 (121.7%).
Thanks in part to the availability of medical facilities, an ample health care workforce, and the presence of the federal government, the District continues to boast the best Disaster Preparedness capacity in the nation. Washingtonians have access to the highest rates of burn unit beds, intensive care unit beds, and verified burn centers. The District also has many important plans and systems in place to address the needs of medically fragile populations during an emergency.
The District made significant gains in its Quality and Patient Safety Environment since the 2009 Report Card by funding both quality improvements in the emergency medical services (EMS) system and an EMS medical director. There are also significantly more emergency medicine residents in the District compared with 2009: 107.5 residents per 1 million people, for which it ranks first in the nation.
The District of Columbia struggles with an adverse Medical Liability Environment that is the worst in the country. The District's courts award more malpractice awards than almost any state (4.8 per 100,000 people), and those payments are among the 10 highest ($416,388). Practitioners in the District face sky-high average medical liability insurance premiums for both primary care physicians ($24,010) and specialists ($110,307). The District has enacted few laws that protect practitioners from frivolous lawsuits, and it allows only periodic payments of malpractice awards at the court's discretion.
Access to Emergency Care in the District is a dichotomy. While enjoying few financial barriers to care and an ample supply of specialists, it has some of the highest hospital occupancy rates and longest ED wait times in the nation. At an average of 452 minutes from ED arrival to ED departure, patients can expect to wait nearly 3 hours longer than the national average to be admitted into a hospital. The District also ranks second to last in the nation for its critical need for primary care providers and last for the proportion of the population with an unmet need for substance abuse treatment.
These basic access issues are particularly worrisome when considering the District's challenges in Public Health and Injury Prevention. The District has the highest homicide and suicide rate in the country, at 29.9 per 100,000 people, compared with the national average of 18.8 per 100,000. The District also has the highest proportion of adults engaging in binge drinking (25.0%) and the highest rate of traffic fatalities that are alcohol-related (50.0%).
The District must act to improve its highly unfavorable Medical Liability Environment and rein in high malpractice awards and insurance premiums. A medical liability cap on noneconomic damages, abolishing joint and several liability, and requiring awards to be offset by collateral sources would help lower the costs of malpractice lawsuits. Pretrial screening panels or case certification provisions would help cull frivolous lawsuits before they begin. Finally, additional liability protections for Emergency Medical Treatment and Labor Act-mandated emergency care would go a long way toward protecting emergency care providers as they serve high-risk patients with little or no knowledge of the patient's medical history.
Significant attention should be given to reducing the excessively long ED wait times facing Washingtonians. To address part of the problem, the District should intensify efforts to increase access to primary care.
There is also evidence of severe racial and ethnic health disparities in the District: The infant mortality rate for Black infants (16.5 deaths per 1,000 live births) is 3.8 times the rate for White infants. Similar disparities exist for cardiovascular disease. The District must ensure that all receive the preventive care, education, and treatment that they need, and it must work to increase the number of primary care providers able to meet those needs.