Michigan has made extensive improvements in its Quality and Patient Safety Environment, implementing key policies and practices to improve the timeliness of emergency care. However, the state's weak Medical Liability Environment and issues with adequate hospital capacity continue to hamper progress in improving the overall emergency care environment.
Michigan has worked to improve its Quality and Patient Safety Environment over the past 5 years. The state has implemented a statewide trauma registry. The vast majority of the state's hospitals have adopted computerized practitioner order entry (91.1%) and electronic medical records (97.5%). Michigan has also begun the process of implementing overall trauma system and destination protocols and is developing administrative rules that will address verification and designation of STEMI and stroke centers, along with triage criteria and destination protocols.
While Michigan has fallen further behind other states in Disaster Preparedness, it maintains a number of policies and procedures to ensure that it can mount a coordinated and effective disaster response. The state has conducted many drills and exercises involving hospitals (4.5 per hospital in 2011) and tracks exercises involving long-term care and nursing home facilities. Special needs patients, patients dependent on dialysis, and mental health patients are included in Michigan's medical response plan, and there is a statewide patient tracking system in place. The state is accredited by the Emergency Management Accreditation Program and has moderate levels of health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals. In terms of hospital capacity, Michigan has better than average access to burn centers and burn unit beds, although its bed surge capacity is relatively low, compared with the rest of the nation.
Michigan's main challenge is ensuring Access to Emergency Care. Although the state has high per capita rates of emergency physicians, it has below average rates of specialists, such as orthopedists and hand surgeons; plastic surgeons; and ear, nose, and throat specialists. There is also concern that Michigan lacks an adequate supply of psychiatric care beds (21.5 per 100,000 people) and staffed inpatient beds (286.9 per 100,000 people). In addition, financial barriers to care may impede access to preventive and emergency care, with a high proportion of adults reporting that they delayed or declined care due to cost (9.3%). Michigan's Medicaid fee levels for office visits are also among the lowest in the nation, at 60.5% of the national average.
In Public Health and Injury Prevention, Michigan falls below average on many indicators, and some worrying numbers stand out: Michigan ranks among the worst in the nation for adult obesity (31.3%) and a relatively high proportion of adults currently smoke (23.3%). The state has one of the lowest rates of pneumonia vaccination among older adults (67.1%). The proportion of older adults receiving an annual influenza vaccination has decreased significantly since the last Report Card, from 71.3% to 58.0%, which may also indicate financial barriers to care.
Michigan should continue to strengthen its Medical Liability Environment, particularly by passing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), such as those requiring clear and convincing evidence of gross negligence, as has been proposed in legislation in recent years. This will help ensure Access to Emergency Care, especially the availability of on-call specialists, which is a major concern in the state. Other potential reforms include abolishing joint and several liability and establishing pretrial screening panels to discourage unfounded lawsuits.
Michigan must work to improve Access to Emergency Care by reducing financial barriers to care and increasing its capacity to care for high-risk patients. The state would also benefit from a concerted immunization outreach and education effort, especially for its older population.
In April 2012, a new law went into effect in Michigan allowing motorcycle riders 21 years of age and older to ride without a helmet. Subsequently, a report from the Governors' Highway Safety Association showed a substantial increase in motorcycle fatalities during the first 9 months of 2012. In addition to the significantly heightened risk of fatal and serious injury associated with repeal of the state's all-rider helmet law, the new law requires helmetless riders to maintain only $20,000 in medical insurance, leaving injured motorcyclists and their families vulnerable to uncovered medical bills. While reinstatement of the all-rider helmet law should be a priority, the state should take steps to ensure that helmetless motorcyclists have adequate insurance to cover treatment of significant injuries and to ensure access to care. Similar attention should be paid to maintaining the state's no-fault automobile insurance provisions that do not limit medical coverage for those severely injured in automobile crashes.