With its strong Medical Liability Environment, Kansas enjoys relatively solid access to health care providers and hospital facilities. However, the state should concentrate on improvements to the Quality and Patient Safety Environment to ensure that its citizens are receiving uniform care that will enhance outcomes in emergencies.
Kansas has the fourth best Medical Liability Environment in the nation, boasting strong protections for health care providers. The state has the seventh lowest average malpractice award payments ($154,127) and well-below-average medical liability insurance premiums for both primary care physicians ($8,610) and specialists ($37,651). Kansas has enacted many reforms that discourage frivolous lawsuits, including voluntary pretrial screening panels whose findings are admissible as evidence and rules on expert witness qualifications. The state's $250,000 cap on non-economic damages was also recently upheld by the state's Supreme Court.
While declining somewhat in Access to Emergency Care since 2009, Kansas continues to enjoy a solid health care workforce with better than average numbers of orthopedists and hand surgeons; plastic surgeons; and registered nurses. The state fared well for Access to Emergency Care facilities, with the third highest per capita rate of emergency departments (ED) (44.7 per 1 million people) and the second lowest ED wait times (180 minutes from ED arrival to departure for admitted patients), despite having one of the lowest rates of emergency physicians in the nation (8.3 per 100,000 people). Kansas has the third lowest hospital occupancy rate in the nation and ranks among the top 10 states in access to accredited chest pain centers and pediatric specialty centers.
Kansas has made several improvements in Disaster Preparedness since the last Report Card. The state's medical response plan now includes special needs patients, patients dependent on medication for chronic conditions, and patients dependent on dialysis. Public health and emergency physician input is included during an Emergency Support Function 8 response, and emergency physicians have input into state disaster planning. In addition, Kansas has a strong infrastructure for a disaster or mass casualty event, with high rates of burn unit beds and intensive care unit beds.
Kansas's poor grade in Quality and Patient Safety Environment is due to a lack of guidelines and protocols for its emergency medical services (EMS) system. For instance, Kansas lacks a uniform system for providing pre-arrival instructions that could aid in providing life-saving care in an emergency and does not have state field triage protocols. Outside of the major metropolitan areas, Kansas does not have triage and destination policies in place for trauma, ST-elevation myocardial infarction (STEMI), or stroke patients. The state has not dedicated funding for quality improvement within the EMS system and lacks a funded state EMS medical director to oversee quality improvement and patient safety in the state.
Although the state performed better than average in Public Health and Injury Prevention, Kansas has a few concerning indicators. The state has a very high rate of fatal occupational injuries (56.1 per 1 million workers), which is only slightly lower than reported in the previous Report Card, and has no funding sources specifically dedicated for occupational injury prevention. Kansas also has a high rate of traffic fatalities, and lacks a ban on handheld cellphone use while driving.
Kansas must invest in quality improvement efforts that will benefit its population, such as instituting a uniform system for providing pre-arrival instructions. The state must consider funding a state EMS medical director position to oversee development and implementation of field triage guidelines and destination policies for stroke, STEMI, and trauma patients to take full advantage of the state's relative abundance of trauma centers and chest pain centers.
The state must continue to support and build on the success it has realized in establishing its first emergency residency program in order to increase the number of emergency physicians, as well as board-certified emergency physicians, practicing in the state. Expanding the size of its residency program would be a significant step in this direction. Kansas also must work to address its high rates of uninsured and underinsured children (9.4 and 21.1%, respectively) to ensure all are able to access care when they need it.
Kansas should continue to improve its Disaster Preparedness by increasing the number of health care providers registered with the Emergency System for Advance Registration of Volunteer Health Professionals. The state has a very low rate of physicians registered (5.9 per 1 million people) and only an average rate of nurses registered (189.5 per 1 million).