With inadequate investment in quality improvement programs, virtually none of the medical liability reforms measured in this Report Card, and inordinately high rates of accident-related fatalities, the emergency care environment in Kentucky needs considerable attention.
Strengths. Contributing to the state’s grade in Access to Emergency Care, Kentucky ranks among the top 15 states in the nation for its low daily hospital occupancy rate (63.2 per 100 staffed beds) and its high rates of staffed inpatient beds (401.2 per 100,000 people) and pediatric specialty centers (4.0 per 1 million people). Kentucky also has relatively high per capita rates of accredited chest pain centers and registered nurses.
Kentucky has implemented a number of measures to advance the state’s readiness in the event of a wide-scale disaster or emergency. The state has made significant progress in registering physicians and nurses with the state-based Emergency System for Advance Registration of Volunteer Health Professionals, for which it ranks 19th and 6th in the nation, respectively. The state has an all-hazards medial response plan and a statewide system for “just-in-time” training during a disaster, as well as statewide patient and victim tracking systems.
Challenges. Access to Emergency Care in Kentucky is challenged by factors such as lower than average Medicaid fee levels for office visits (72.4 percent of the national average) that have not increased since 2004. Kentucky also has lower than average rates of physicians accepting Medicare (2.5 per 100 beneficiaries versus an average of 3.2 across the states). Access to specialists is of particular concern in Kentucky, where per capita rates of specialists consistently fall well below average.
The Quality and Patient Safety Environment in Kentucky receives a poor grade, due in part to a lack of funding for quality improvement within the EMS system, no uniform system for providing pre-arrival instructions, no PCI network or STEMI system of care, and no requirements for reporting hospital-based infections and adverse events. The state also receives a low ranking (46th) for the percentage of patients with acute myocardial infarction who receive PCI within 90 minutes of arrival.
Several efforts to enact medical liability reforms in Kentucky by passing legislation or amending the state constitution have failed. As a result, the state continues to lack a medical liability cap on non-economic damages, liability protections for
EMTALA-mandated emergency care, requirements for case certification by an expert witness, or expert witness rules requiring the witness to be of the same specialty as the defendant.
Kentucky’s low rank for Public Health and Injury Prevention masks wide variations. Kentucky ranks among the worst states for the low rate of seat belt use (48th) and high traffic fatality rate (41st). The state has high rates of unintentional fatal injuries, and ranks 43rd for its high percentage of obese adults. The state also has the highest percentage of adult smokers in the nation (28.5 percent). In contrast to these poor rates, however, the state has the second lowest percentages of binge drinkers (8.6 percent of adults) and alcohol-related traffic fatalities (30.0 percent).
Recommendations. Kentucky must find a way to improve its poor Medical Liability Environment as a first step in addressing the shortage of specialists in the state. Emergency physicians in the state report problems with on-call specialist coverage for emergency patients. The state could attempt to alleviate this problem by enacting special liability protections for EMTALA-mandated emergency care. At the same time, Medicaid reimbursement rates should be increased to encourage more primary care physicians to see Medicaid patients, thereby improving access to care for the state’s Medicaid population.
Kentucky’s emergency physicians also report problems with hospital crowding and boarding of emergency patients, particularly at university trauma centers. With its lower than average hospital occupancy rate, Kentucky may be better positioned than some states to facilitate the movement of admitted patients out of the emergency department.
The state should work to address its failing grade in the Quality and Patient Safety Environment by providing funding for quality improvement within the EMS system and developing a uniform system for pre-arrival instructions as first steps in the process.