With significant shortages of primary care physicians and specialists, low Medicaid reimbursement rates, and few medical liability reforms, Michigan’s emergency care environment is threatened by a multitude of vexing problems.
Strengths. Michigan’s grade in Disaster Preparedness is largely due to the multiple systems and plans that have been put in place. The state has an all-hazards medical response plan, as well as written plans specifically for special needs patients. Michigan has statewide “just-in-time” training systems and statewide patient and victim tracking systems.
With respect to Public Health and Injury Prevention, Michigan fared quite well regarding injury prevention funding and traffic safety. The state invests more money in intentional injury prevention than do most states ($171 per 1,000 people versus an average of $158 across the states). The state has multiple child restraint and seat belt laws, a universal motorcycle helmet law, and a higher-than-average use of seat belts among front seat occupants (93.7 percent). Michigan also has the 11th lowest traffic fatality rate in the nation (10.8 per 100,000 people).
Challenges. Michigan has been especially affected by the current economic downturn, which may have played an important role in the state’s poor performance on several key indicators. For instance, Access to Emergency Care poses serious problems for the state. The state experienced two hospital closures in 2006 and has relatively low rates of inpatient and psychiatric care beds (289.3 and 23.5 per 100,000 people, respectively). Michigan faces significant shortages of primary care providers and specialists, such as ear, nose, and throat specialists; neurosurgeons; orthopedists; and hand surgeons. Contributing to these barriers to medical care are relatively low Medicaid reimbursement rates for office visits (79.9 percent of the national average).
Michigan received a poor grade for its Medical Liability Environment. While the state has implemented a cap on non-
economic damages, it has not been successful in reducing insurance premiums: The state has among the six highest medical liability insurance premiums for primary care physicians and specialists ($29,712 and $98,951, respectively). The state also ranks 46th for the low number of insurers writing medical liability policies (2.4 per 1,000 physicians). This may be indicative of the state’s failure to enact numerous reforms, including additional liability protections for EMTALA-mandated emergency care, mandatory pretrial screening panels, and joint and several liability reform.
Michigan’s grade in the Quality and Patient Safety Environment stems from a lack of systems to ensure uniform quality controls and measures. There are no reporting requirements for adverse events or hospital-based infections. In addition, the state does not maintain a statewide trauma registry. The state also lacks funding for quality improvement within the EMS system and a state EMS medical director position.
Recommendations. Michigan suffers from a lack of specialists of all types. Emergency physicians in the state report significant shortages of specialists willing to provide on-call services to emergency patients. The on-call crisis, combined with hospital closures and low rates of inpatient beds, may all contribute to other serious problems reported by emergency physicians, including hospital crowding, boarding of patients in emergency departments, and ambulance diversion. It is imperative that the state work with the medical community to address these issues in order to continue providing quality care to those most in need. The state should also begin collecting data on ambulance diversion.
Systems must be instituted to ensure the quality controls and uniformity needed to improve Access to Emergency Care and the Quality and Patient Safety Environment. For example, while the state legislature has approved a plan for a statewide trauma system, the state needs to provide appropriate funding to develop and implement such a system. The state also should fund a state EMS medical director position and provide funding for quality improvement within the EMS system.
Michigan must enact medical liability reforms. In order to help encourage specialists to provide emergency on-call services, legislators should reduce the current medical liability cap on non-economic damages and enact additional liability protections for EMTALA-mandated emergency care. The Medical Liability Environment would benefit significantly from increasing the threshold for medical liability suits from “simple negligence” to “gross negligence” for licensed health care professionals and facilities providing emergency care.