Iowa ranks 11th in the nation for its overall emergency care environment, with a strong commitment to Public Health and Injury Prevention and notable improvements in its Disaster Preparedness and Quality and Patient Safety Environment. However, the state faces critical health care workforce shortages and must continue to improve the Medical Liability Environment.
Iowa's best performance was in Public Health and Injury Prevention. Iowa supports relatively high injury prevention funding ($588.66 per 1,000 people) and enjoys low fatal injury rates. For instance, it has the eighth lowest rate of homicide and suicide (14.2 per 100,000 people). For motor vehicle accidents, it has a very low rate of traffic fatalities that are alcohol-related (27%), and one of the lowest pedestrian fatality rates in the country (1.7 per 100,000 pedestrians). Iowa fares well with immunizations, ranking second in the nation for influenza vaccination among older adults (70.2%). It has an exceedingly low infant mortality rate (4.9 per 1,000 live births) and a below-average rate of childhood obesity (13.6%).
Iowa has made notable improvements to its Disaster Preparedness practices and policies since the last Report Card, more than doubling bed surge capacity (1,742.6 beds per 1 million people) to the third highest in the country, as well as incorporating patients dependent on medication for chronic conditions into its medical response plan. It also has the fifth highest percentage of nurses who have received disaster training (47.2%), and it has substantially increased the per capita rates of physicians, nurses, and behavioral health providers registered in the Emergency System for Advance Registration of Volunteer Health Professionals (ESARVHP), though these rates still fall well below the national average.
Although Iowa has a strong showing in many areas of Access to Emergency Care, the state is facing a severe shortage of health care providers. It has the lowest per capita rate of emergency physicians in the nation, (6.8 per 100,000 people). Iowa also lacks neurosurgeons, plastic surgeons, and orthopedists and hand surgeons, ranking almost last in the nation for all these specialties. It is below average in terms of access to physicians accepting Medicare fee-for-service patients, a trend that is likely to worsen as the population ages. The state's Medicaid fee levels have declined by 1.2% since 2007, a troubling trend in light of the state's decision to expand Medicaid under the Affordable Care Act.
Iowa has developed a percutaneous coronary intervention network or a ST-elevation myocardial infarction (STEMI) system of care and increased the number of emergency medicine residents since the last Report Card, which has helped to improve its overall standing in Quality and Patient Safety Environment. However, the state lacks important provisions, including triage and destination policies for stroke and STEMI patients that allow emergency medical services (EMS) to bypass local hospitals for medical specialty centers. Iowans also could benefit from the implementation of a uniform system for providing pre-arrival instructions, which could help to administer life-saving care while awaiting EMS arrival.
Iowa's Medical Liability Environment ranks squarely in the middle of the pack. Although Iowa has relatively low average medical liability insurance premiums for primary care physicians ($7,280) and specialists ($32,184), it has few protections in place for providers, including those responsible for administering emergency care.
Limited access to specialists and other health care providers continues to burden the Iowa health care system. The state must work to attract and retain a skilled health care workforce to handle the growing heath care needs of its population. Increasing Medicaid fee levels to meet or exceed the national average may help address the problem, as would a more favorable Medical Liability Environment.
Iowa should enact liability protections for providers administering care mandated by the Emergency Medical Treatment and Labor Act: care to high-risk patients when the provider does not have a preexisting patient relationship and has little to no knowledge of a patient's medical history. Additionally, pretrial screening panels or provisions for case certification could help discourage frivolous lawsuits, and a medical liability cap on non-economic damages could prevent excessive verdicts.
Despite its stellar score in Public Health and Injury Prevention, Iowa has one of the higher rates of fatal occupational injuries (48.5 per 1 million workers). Dedication of funds specifically for occupational injury prevention may be useful in addressing this concern. Iowa also needs to reach out to medical professionals and increase registration in ESAR-VHP to increase the state's ability to respond quickly to a major disaster or mass casualty event.