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.
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.