Category Grades
1B 2B-
Access to Emergency Care:
3B 4B
Quality/Patient Safety:
6A 5B+
Medical Liability:
33D 40D-
Public Health/ Injury Prevention:
1A 1A
Disaster Preparedness:
19B 20C

Massachusetts is the second highest ranked state in the nation for its overall emergency medical care system, with a statewide commitment to Access to Emergency Care, Public Health and Injury Prevention, and the Quality and Patient Safety Environment. However, Massachusetts continues to lag behind other states with regard to its Medical Liability Environment and has not improved in Disaster Preparedness.

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Massachusetts ranks first in the nation in Public Health and Injury Prevention, bolstered by dedicated funding for injury prevention efforts for both children and the elderly as well as low rates of fatal injuries. Notably, Massachusetts has the lowest rate of homicide and suicide (11.2 per 100,000 people) in the nation and one of the lowest rates of fire- and burn-related deaths (0.5 per 100,000). The state has high rates of vaccinations for both children and older adults and low rates of chronic disease risk factors among adults, such as smoking (18.2%) and obesity (22.7%).

The Quality and Patient Safety Environment in Massachusetts continues to surpass most other states. Massachusetts maintains a statewide trauma registry and has triage and destination policies in place for trauma, stroke, and ST-elevation myocardial infarction (STEMI) patients, which allow emergency medical services teams to bypass local hospitals for medical specialty centers. The state has also developed and implemented state field triage protocols based on CDC guidelines and maintains a prescription drug monitoring program (PDMP) that monitors schedule II-V drugs. As PDMP regulations are finalized, the state should continue to ensure that emergency providers are not burdened by a mandate to check the program when it is not clinically indicated.

Massachusetts patients enjoy good Access to Emergency Care. The state has high per capita rates of specialists, emergency physicians, and registered nurses, as well as the lowest rates of adults and children with no health insurance (3.6% and 2.5%, respectively), largely due to its health insurance mandate. Massachusetts has a high rate of Medicare fee-for-service physicians (4.1 per 100 beneficiaries) and the need for additional primary care and mental health providers is less than in most states. The state's Medicaid fee levels are slightly higher than the national average (107.1%).


Massachusetts' Medical Liability Environment lags behind the rest of the country, with relatively few liability reforms in place and one of the highest average malpractice award payments in the country at $519,991ómore than $200,000 higher than the national average. There have been small advances in this area in recent years. Massachusetts included apology inadmissibility language in the state's new health care reform law, and the state developed a demonstration project to examine the benefits of a ìDisclosure, Apology and Offerî system for early resolution of medical malpractice claims. Massachusetts must continue to build on these efforts to bring the state's excessive medical malpractice awards more in line with national averages.

In Access to Emergency Care, Massachusetts still has a relatively high proportion of adults with an unmet need for substance abuse treatment (9.9%), although the state is working on addressing this gap. Stakeholders have worked to improve the response to all behavioral health patients, including those patients with substance abuse and dual diagnoses. This includes working to see that insurers eliminate preauthorization screening to ensure that these patients are treated the way other patients are treated. The state should work to stem the reduction in the number of psychiatric beds per capita that has occurred over the past five years.


Massachusetts must work to improve its Medical Liability Environment. One particularly important reform would be passing additional liability protection for Emergency Medical Treatment and Labor Act-mandated emergency care. Massachusetts' policymakers should also closely monitor the effectiveness of the state's new ìDisclosure, Apology, and Offerî demonstration project as part of an ongoing effort to identify, adopt, and expand meaningful reforms that can help contain high costs associated with medical malpractice litigation and further support the provision of quality patient care.

Massachusetts scores relatively well in Disaster Preparedness, but it has one of the lowest bed surge capacities in the nation (248.6 beds for every 1 million people). Massachusetts also has a relatively low capacity of intensive care unit beds (248.4 per 1 million people). Similarly, while Massachusetts has overall superior Access to Emergency Care, the relative lack of emergency departments (ED) (9.6 per 1 million) and high hospital occupancy rate (75.0 per 100 staffed beds) point to an overwhelmed emergency care infrastructure. This is reflected in long ED wait times (311 minutes from ED arrival to ED departure for admitted patients) that are higher than the national average. Massachusetts should work to increase hospital capacity to ensure that admirable levels of timely, high-quality care can continue to be provided throughout the state.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 12.1 14.2
Emergency physicians per 100,000 pop 16.9 19.7
Neurosurgeons per 100,000 pop 2.4 2.6
Orthopedists and hand surgeon specialists per 100,000 pop 13 12.7
Plastic surgeons per 100,000 pop 3.1 3.3
ENT specialists per 100,000 pop 4.2 4.2
Registered nurses per 100,000 pop 1,216.6 1,317.4
Percent of children able to see provider 97.3
Level I or II trauma centers per 1M pop 1.2 1.4
Percent of population within 60 minutes of Level I or II trauma center 97 99
Accredited chest pain centers per 1M pop 0.2 0.2
Percent of population with an unmet need for substance abuse treatment 8.7 9.9
Pediatric specialty centers per 1M pop 2.3 2.1
Medicaid fee levels for office visits as a percent of the national average 111.8 107.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 10 17.8
Percent of adults with no health insurance 11.4 3.6
Percent of adults underinsured 6.9
Percent of children with no health insurance 7 2.5
Percent of children underinsured 17.5
Percent of adults with Medicaid 10.9 17.7
Hospital closures in 2006/2011 0 1
Staffed inpatient beds per 100,000 pop 353.9 321.2
Hospital occupancy rate per 100 staffed beds 75.4 75
Psychiatric care beds per 100,000 pop 28.5 27.4
Median time from ED arrival to ED departure for admitted ED patients 311
State collects data on diversion YES N/A

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $10.53 $6.54
State budget line item health care surge NR
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) YES, ACCREDITED CONDITIONALLY
Special needs patients included in medical response plan NR YES
Patients dependent on medication for chronic conditions in medical response plan NR YES
Medical response plan for supplying dialysis NR YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place COUNTY OR CITYWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, IN METROPOLITAN AREAS
Bed surge capacity per 1M pop 305.6 248.6
ICU beds per 1M pop 290.9 248.4
Burn unit beds per 1M pop 10.7 10.5
Verified burn centers per 1M pop 0.465133947 0.5
Physicians registered in ESAR-VHP per 1M pop 56 87.6
Nurses registered in ESAR-VHP per 1M pop 232.7 537.2
Behavioral health professionals registered in ESAR-VHP per 1M pop 50.9
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, NO NO, YES
Percent of RNs that received emergency training 33.8 35.4

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 22.4 24.5
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 13.2 12.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 0.9 1.4
Average malpractice award payments $437,000 $519,911
National Practitioner Databank reports per 1,000 physicians 13.7 17.3
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 1.9 2.4
Average medical liability insurance premiums for primary care physicians $12,627 $15,235
Average medical liability insurance premiums for specialists $65,185 $77,658
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion NO NO
Medical liability cap on non-economic damages >$500,000 >$500,000
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant NO NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 1.9
Pedestrian fatalities per 100,000 pedestrians 2.1
Percent of traffic fatalities alcohol-related 40 39
Percent of front occupants using restraints 68.7 73.2
Child safety seat/seat belt legislation - score out of a possible 10 points 5 5
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 87 80.3
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 73.1 66.9
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 70.8 72.2
Fatal occupational injuries per 1M workers 22.6 16.5
Homicides and suicides (non-motor vehicle)(per 100,000) 10.2 11.2
Unintentional fall-related fatal injuries (per 100,000) 4.2 7.9
Fire/burn related fatal injuries (per 100,000) 0.8 0.5
Rate of unintentional firearm-related fatal injuries (per 100,000) 0 0
Rate of unintentional poisoning-related deaths (per 100,000) 10.5
Total injury prevention funds per 1,000 persons $499.71 $2,950.94
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 5.2 4.4
Percentage of adults who binge drink 17.7 20.6
Percentage of adults who currently smoke 17.8 18.2
Percentage of adult population who are obese (BMI > 30.0) 20.3 22.7
Percentage of children who are obese 14.5
Cardiovascular disease disparity ratio 2.5
HIV diagnosis disparity ratio NR
Infant mortality disparity ratio 2.7

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES NO
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 30.2 33.1
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 43.5 92.7
% of hospitals with electronic medical records 61.9 97.6
% of patients with AMI given PCI within 90 minutes of arrival 65 95
Median time to transfer to another facility for acute coronary intervention 59
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 52.3
% of hospitals with or planning to develop a diversity strategy or plan 46.8

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