Despite receiving an A for its Medical Liability Environment, Georgia faces numerous challenges ranging from provider shortages and high numbers of uninsured residents to inadequate support for key quality and disaster preparedness initiatives.
Strengths. Georgia has enacted significant liability reform laws that are already helping to reduce frivolous lawsuits and lower medical liability insurance premiums, as well as attract and retain physicians, especially in high-demand specialties, such as surgery and obstetrics. The state has a medical liability cap on non-economic damages in addition to having eliminated joint and several liability. The state also provides additional liability protections for EMTALA-mandated emergency care. Georgia has implemented a number of expert witness rules, including requiring case certification by an expert witness and requiring witnesses to be of the same specialty as the defendant. The state is also one of only four to have mandated that expert witnesses be licensed to practice medicine in the state.
Though Georgia faces important challenges in Access to Emergency Care, the state ranks first in the nation for patient access to substance abuse treatment services. The vast majority of the population (83.8 percent) lives within 60 minutes of a Level I or II trauma center. In addition, the Medicaid reimbursement rate for office visits is slightly higher than the national average (109.0 percent).
Challenges. Despite enacting numerous liability reforms, Georgia continues to face serious shortages of health care providers. The state ranked among the bottom 12 for its low rates of registered nurses, emergency physicians, primary care physicians, and specialists, such as orthopedists and hand surgeons, neurosurgeons, and mental health providers. Georgia also faces challenges regarding the financial health of the state’s largest hospital. Further affecting access issues in Georgia are higher than average rates of uninsured adults (19.5 percent compared to 17.2 percent nationally) and children (12.8 percent compared to 11.7 percent nationally).
The Quality and Patient Safety Environment in Georgia is also challenged. The state lacks funding for quality improvement within the EMS system, as well as a uniform system for providing pre-arrival instructions. In addition, Georgia has a relatively low rate of emergency medicine residents (8.8 per 1 million people) and does not require hospital-based infections reporting.
Georgia demonstrates a number of limitations with regard to Disaster Preparedness. The number of nurses and physicians registered with the state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP; 23.6 and 2.7 per 1 million people, respectively) falls well below the average across the states (125.5 and 44.2 per 1 million, respectively). The state has neither patient nor victim tracking systems, and it lacks a written plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during an emergency event.
Recommendations. Georgia has made great progress in improving its Medical Liability Environment. It is vital that policymakers do not roll back this progress as a result of the continuous pressure from medical liability reform opponents.
In order to address the state’s poor grade regarding Access to Emergency Care, Georgia will need to explore multiple strategies for recruiting and retaining more registered nurses, emergency physicians and residents, primary care providers, and critical medical specialists. Though the Medicaid reimbursement rate for office visits is slightly higher than the national average, that rate has remained unchanged since 2004–2005 (not accounting for inflation). Raising Medicaid reimbursement for a wide range of specialty services may also encourage and attract a broader workforce.
Georgia will benefit from development of uniform systems for pre-hospital instructions, hospital-based infections reporting, and further preparation for responding to disasters. The latter should consist of taking an active role in registering nurses and physicians with ESAR-VHP and developing uniform patient and victim tracking systems.