With significant shortages of providers, few programs to improve quality and patient safety and a lack of critical disaster preparedness systems, Idaho’s overall emergency care environment is among the worst in the country.
Strengths. Idaho has a rather favorable Medical Liability Environment. The state ranks among the best states with regard to average medical liability insurance premiums for primary care physicians and specialists ($6,884 and $35,547, respectively). These rates are roughly half the average premiums across the states. Idaho also has a relatively high number of insurers writing medical liability policies (21.4 per 1,000 physicians). The state has a medical liability cap on non-economic damages, as well as mandatory pretrial screening panels. Although the state doesn’t require expert witnesses to practice in the same specialty as the defendant, Idaho has a “local standard of care” mandate that requires witnesses to have an understanding of the standard of care in the community where the defendant practices.
Challenges. Idaho is experiencing a scarcity of medical professionals, which significantly affects Access to Emergency Care throughout the state. Idaho ranks among the worst 6 states for its lack of plastic surgeons; ear, nose, and throat specialists; and registered nurses per capita. While the state has a relatively high rate of emergency departments (20.5 per 1 million people), access to trauma centers remains a serious concern: less than 29 percent of Idaho’s population is within 60 minutes of a Level I or II trauma center. The state also has a below-average rate of psychiatric care beds (29.0 per 100,000 people). Emergency physicians in the state are reporting increasing problems with psychiatric patients being boarded in emergency departments, largely because of a lack of psychiatric beds.
Idaho’s Disaster Preparedness also needs significant improvement. The state lacks patient and victim tracking systems, as well as a real-time syndromic surveillance system. In addition, Idaho lacks the ability to verify the credentials of volunteer health professionals and assign them to one of four levels in a state-based Emergency System for Advance Registration of Volunteer Health Professionals program. The state also has no verified burn centers or burn unit beds.
Idaho faces numerous challenges with regard to Public Health and Injury Prevention. The state has relatively low levels of immunization among older adults. Fewer than 63 percent of adults aged 65 and older have ever received the pneumococcal vaccine, while 65.2 percent receive an annual influenza vaccine. The state also has a higher than average rate of traffic fatalities (18.2 per 100,000 people) and relatively low seat belt usage (78.5 percent of front occupants).
Recommendations. Emergency physicians in the state report that access to specialists of all types and especially on-call specialists is a serious problem in Idaho. To help attract providers to the state and encourage specialists to provide emergency on-call services, the state should ensure that reimbursement practices and payment rates are adequate and consider enacting additional liability protections for providers of EMTALA-mandated emergency care.
Idaho can significantly improve its Quality and Patient Safety Environment by pursuing statewide system changes. The state could provide funding for an EMS medical director and institute a uniform system for providing pre-arrival instructions. In addition, the state should seek to create a regionalized trauma system to address the low percentage of the population with access to Level I or II trauma centers.
State officials should also review Idaho’s disaster preparedness plans and programs and develop a prioritized action plan to address key deficiencies noted above.
Finally, Public Health and Injury Prevention could be significantly improved through implementation and enforcement of a universal motorcycle helmet law and a primary seat belt law, which may help to decrease the traffic fatality rate and increase front occupant restraint use. The state would also benefit from outreach efforts to increase immunization rates among both children and adults.