A commitment to Disaster Preparedness and a high concentration of facilities and providers within a small geographic area helped propel the District of Columbia to the second highest ranking in the country. But significant problems abound, including a high rate of violent fatalities, insufficient immunizations of the elderly, a lack of EMS funding, and the worst Medical Liability Environment in the country.
Strengths. The District of Columbia enjoys the highest rates of emergency physicians; neurosurgeons; orthopedists and hand surgeons; plastic surgeons; ear, nose and throat specialists; and registered nurses. In addition, the District has the highest rate of physicians accepting Medicare (11.3 per 100 beneficiaries) and the highest rate of staffed inpatient beds (891.9 per 100,000 people). In addition to lower than average rates of uninsured adults and children, the District has shown commitment to insuring adults with the fourth highest percentage of adults covered by Medicaid (13.7 percent).
The District of Columbia also scores well with regard to Disaster Preparedness, as one would expect of the nation’s capital. The District has more ICU and burn unit beds, as well as more verified burn centers per 1 million people than any single state. The District also receives the highest level of federal funding in the country designated for disaster preparedness ($160.57 per capita). With regard to deployment of medical professionals, the District has medical strike teams or medical assistance teams and requires EMS and essential emergency department personnel to be compliant with the National Incident Management System (NIMS).
Challenges. The Medical Liability Environment in the District of Columbia is not supportive of the medical community. The District ranks 50th with regard to the number of malpractice awards (8.0 per 100,000 people). In comparison, the average across the states was 2.4 awards per 100,000. The average amount for a malpractice award in the District is $366,131, compared with the average across the states of $285,218. At the same time, the average medical liability insurance premiums for primary care physicians and specialists are among the highest in the country ($24,010 and $110,306, respectively). The District also lacks significant liability reforms including a medical liability cap on non-economic damages and expert witness rules requiring witnesses to be of the same specialty as the defendant.
The District of Columbia gave a mixed performance with regard to the Quality and Patient Safety Environment. While the District demonstrates high rates of information technology use in hospitals, it ranks among the worst with regard to the percent of patients with acute myocardial infarction given PCI within 90 minutes of arrival (41 percent). In addition, there is no funding for quality improvement within the EMS system.
The District’s grade in Public Health and Injury Prevention is due to poor rankings on a number of indicators. While it has a relatively high percentage of children who are immunized, the District of Columbia ranks among the worst with regard to immunizations for older adults. Only 61.2 percent of adults aged 65 and older receive yearly influenza vaccines, and just 52.0 percent have ever received the pneumococcal vaccine. The percentage of traffic fatalities that are alcohol related is disproportionately high (48.0 percent), compared to the national rate (42 percent).
Recommendations. Policymakers in the District of Columbia need to develop a more supportive Medical Liability Environment by taking action to reduce liability insurance premiums in the District. Positive steps in this direction would be to institute a $250,000 medical liability cap on non-economic damages and implementation of expert witness rules, such as providing for case certification by an expert witness and requiring the witness to be of the same specialty as the defendant.
The Public Health and Injury Prevention grade could be significantly improved by addressing a number of concerns. First, the District should address the relatively low rate of immunizations among the older adult population. In addition, the District of Columbia government, residents, and law enforcement need to work together to address the high rate of homicides and suicides (36.6 per 100,000 people).