With ample medical facilities and high rates of insured children, Kentucky has improved somewhat in Access to Emergency Care. However, the state's poor Medical Liability Environment and lack of provisions to improve the Quality and Patient Safety Environment bring the state's overall emergency care environment to fifth worst in the nation.
Kentucky ranks 12th in the nation in Access to Emergency Care, largely due to improvements in key measures since the previous Report Card. Kentucky's citizens enjoy increasing access to accredited chest pain centers (5.5 per 1 million people) and above-average per capita rates of pediatric specialty centers (3.9 per 1 million people). Access to behavioral health care is also relatively strong, with a low rate of unmet need for substance abuse treatment (7.3%) and one of the nation's highest per capita rates of psychiatric care beds (34.5 per 100,000 people).
Kentucky has also increased Medicaid fee levels for office visits by 58.0% since 2007, although those payments continue to lag behind the national average. Kentucky also has some bright spots in Disaster Preparedness, including the fifth highest bed surge capacity (1,707.8 per 1 million people). The state's Disaster Preparedness plans are relatively comprehensive, and statewide systems are in place, such as a just-in-time training system and a statewide medical communication system with one layer of redundancy.
Kentucky continues to suffer from a poor Medical Liability Environment, having made no progress since the previous Report Card and failing to enact even the most basic reforms, such as apology inadmissibility laws that would allow providers to apologize to patients and their families for unfortunate circumstances without fear that it will be used against them as evidence in court. The state also lacks pretrial screening panels and a process for case certification by expert witnesses.
Kentucky lags in its Quality and Patient Safety Environment. Although it does have a funded state EMS medical director, Kentucky lacks some state-level protocols that can ensure that emergency patients receive life-saving care, such as a uniform system for providing pre-arrival instructions, and triage and destination policies for ST-elevation myocardial infarction (STEMI) patients. The state does not require adverse event reporting, which can help track and prevent medication errors and unfavorable patient outcomes.
In the area of Public Health and Injury Prevention, Kentucky has some bright spots, such as the fourth highest rate of childhood immunizations and above-average rates of influenza vaccinations for older adults. These indicators are tempered by high health risk factors. Kentucky has the highest rate of adult smoking in the nation (29.0%), and weak antismoking laws increase opportunities for secondhand smoke exposure. Kentucky also has among the highest rates of adult and child obesity in the country (30.4 and 19.7%, respectively). Additionally, a high cardiovascular disease disparity ratio indicates that some racial and ethnic groups lack access to proper prevention and medical care.
Kentucky must work to improve its failing grade in Quality and Patient Safety by continuing to develop and improve statewide emergency response policies. The state should investigate implementing statewide policies to improve and standardize care, including destination policies for STEMI and stroke patients, which could benefit from the state's relatively high rate of accredited chest pain centers.
Kentucky is long overdue for improving its Medical Liability Environment. The state must work to implement expert witness rules that require experts to be of the same specialty as the defendant and licensed to practice medicine in the state. Requiring case certification by expert witnesses may also reduce the number of frivolous malpractice cases brought to court, alleviating this burden on providers, patients, and the court system as a whole. Kentucky should also consider implementing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), which requires physicians to provide lifesaving care, often without a preexisting patient relationship and little to no knowledge of a patient's medical history.
While Kentucky's decision to expand Medicaid under the Patient Protection and Affordable Care Act undoubtedly will help increase health insurance coverage among adults, the state must continue to increase reimbursements for providers accepting Medicaid. While Kentucky has increased fee levels since 2007, these rates still fall below the national average and may not be sufficient to attract and retain primary care providers needed to meet increasing health care demands.