While New York's overall grade remains unchanged, improved rankings in Access to Emergency Care, Public Health and Injury Prevention, and Disaster Preparedness have helped boost the state from 21st to a tie for 13th place overall. At the same time, New York has failed to pass meaningful medical liability reforms and has worsened in comparison to other states with regard to the Quality and Patient Safety Environment.
New York continues to improve in Public Health and Injury Prevention, with a significant increase in the proportion of New Yorkers wearing seat belts, a requirement that motorcycle riders wear helmets, and distracted-driving laws prohibiting cellphone use and texting. These factors have likely contributed to the third lowest rate of traffic fatalities in the nation (4.4 per 100,000 people).
New York earned a solid mark in Disaster Preparedness. It is one of only 11 states with a budget line item specifically for health care surge and one of 14 that requires training in disaster management and response for emergency medical services (EMS) personnel. New York also has some of the highest per capita rates of physicians and behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals.
New York's Quality and Patient Safety Environment reflects generally positive results. The state ranks among the best with regard to hospital adoption of electronic medical records (99.0%) and computerized practitioner order entry (87.6%). The state has also implemented a prescription drug monitoring program and has destination policies in place for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients.
New York's Medical Liability Environment continues to be among the worst in the nation with the highest number of malpractice award payments in the country (6.1 per 100,000 people), representing a twelve-fold increase since the 2009 Report Card. The average malpractice award payment has increased from $356,003 to $409,773 during the same period. New York has some of the highest average medical liability insurance premiums for primary care physicians and specialists and few insurers writing policies.
While New York has improved in Access to Emergency Care with more registered nurses, specialists, and board-certified emergency physicians since 2009, much more work needs to be done. The state has the highest hospital occupancy rate in the nation (80.3 per 100 staffed beds) and the fourth fewest emergency departments per capita (8.0 per 1 million people). The number of staffed inpatient beds has decreased since 2009. All these factors contribute to emergency department (ED) boarding and crowding and the fourth longest average ED wait time in the nation: 366 minutes, or 6.1 hours. The state also faces challenges with access to primary care, needing an additional 2.8 full-time primary care physicians per 100,000 people to meet the needs of its population. Despite an increase in Medicaid fee levels for office visits between 2007 and 2012, the state's fee levels are still only 77.3% of the national average, creating an additional barrier to care.
New York must work to improve the Medical Liability Environment to ensure access to timely, high-quality emergency care. The state should pursue legislation to provide special liability protections for care mandated by the Emergency Medical Treatment and Labor Act, recognizing the risks associated with providing immediate care in life-threatening situations, often without knowledge of the patient's medical history. Doing so would encourage specialists to provide on-call services to EDs and improve the quality of care for all New Yorkers. The state should also investigate pretrial screening panels, a cap on non-economic damages, and a requirement that expert witnesses be of the same specialty as the defendant.
Emergency department crowding remains a major concern in New York. The state must take immediate action to alleviate long ED wait times, boarding, and crowding in order to ensure the best patient outcomes. Efforts also need to be made to increase access to primary and mental health care to ensure that those who need it are not forced to delay seeking care.
New York should continue to build on progress that has been made with regard to Public Health and Injury Prevention by instituting graduated driver's license laws that require a greater number of supervised practice hours and a ban on teen passengers. The state should also make an aggressive effort to improve immunization rates for the elderly and for children.
New York should support a statewide quality improvement initiative to allow for standardization of care and to further align EMS with established quality improvement systems in other areas of medicine. Additionally, the state should identify and support a state EMS medical director to provide clinical leadership and align New York with nationally established best practices in out-of-hospital emergency medical care.