Kansas has one of the most favorable Medical Liability Environments in the nation and outperforms most states with its low percentage of uninsured residents, high rates of critical health care facilities, and increasing Medicaid reimbursement rates for office visits. However, the area of Disaster Preparedness needs significant attention.
Strengths. Kansas enjoys a highly favorable Medical Liability Environment. The average malpractice award payment in the state ($181,675) is the fourth lowest in the nation. Likewise, the average medical liability insurance premium for primary care physicians and specialists ($10,367 and $46,060, respectively) situate Kansas among the 15 states with the lowest rates. The state boasts a $250,000 cap on non-economic damages, and in 2008, it implemented pretrial screening panels.
The state’s high rank in Access to Emergency Care is largely attributable to relatively low rates of uninsured residents, high rates of hospital beds and facilities, and Medicaid fee levels for office visits that are above the national average and that have increased 54.3 percent from 2004 to 2007. Only 14.0 percent of adults and 7.3 percent of children are uninsured in Kansas, compared to 17.2 and 11.7 percent, respectively, nationwide. Kansas is among the top five states for its high rates of psychiatric care beds and emergency departments per capita, as well as its low daily hospital occupancy rate.
While overall Kansas did not fare well with regard to Disaster Preparedness, the state has an all-hazards medical response plan, as well as a plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during a disaster event. In addition, the state benefits from the second highest bed surge capacity in the nation (1,489.6 beds per 1 million people).
Challenges. The Quality and Patient Safety Environment in Kansas faces a number of challenges including a lack of emergency medicine residents, no funding for quality improvement within the EMS system or for a state EMS medical director position, and the absence of a uniform system for providing pre-arrival instructions.
Although Kansas has suffered multiple devastating natural disasters in recent years, including major tornadoes, floods, and severe storms, the state receives only $7.93 per person in federal disaster preparedness funds compared to an average of $13.82 per capita across the states. The state lacks specific written plans for special needs patients, for those on dialysis, and for supplying medications for chronic conditions in the event of a disaster. In addition, while Kansas does have an Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program, the state has failed to register any physicians.
While Kansas ranks among the top 12 states in terms of influenza and pneumococcal vaccination rates among residents aged 65 years or older, there were a few notable issues of concern related to Public Health and Injury Prevention. The percentage of children who receive the recommended schedule of immunizations is slightly below the national rate (79.0 percent versus 80.5 percent, respectively). The state also has a below average rate of front occupant restraint use (75.0 percent) and a relatively high rate of fatal occupational injuries (60.3 per 1 million people).
Recommendations. Kansas has already begun to improve the Quality and Patient Safety Environment. The University of Kansas School of Medicine is establishing an emergency medicine residency program, which is expected to admit its first group of residents in 2009–2010. Other efforts to address deficiencies in this category should include providing funding for quality improvement within the EMS system and a state EMS medical director position.
With the state’s vulnerability to natural disasters, there is a clear need for increased investment in disaster planning in Kansas, along with continued efforts to expand planning, implement disaster training requirements, develop strike teams or medical assistance teams, and enroll physicians in the ESAR-VHP system.
Furthermore, Kansas could improve its Public Heath and Injury Prevention grade by promoting and enforcing front occupant restraint use and making efforts to help employers decrease the likelihood of fatal occupational injuries.