With a wide array of problem areas and below average scores in every category, New Mexico ranks third to last in the nation for its overall emergency care environment.
Strengths. Policies and systems have been implemented to help improve the Quality and Patient Safety Environment in New Mexico. The state provides funding for quality improvement within the EMS system, as well as a state EMS medical director position. There is a uniform system for providing pre-arrival instructions and a statewide trauma registry. In addition, high proportions of hospitals use electronic medical records (57.9 percent) and computerized practitioner order entry (39.5 percent) to promote greater accuracy, tracking, and safety.
While New Mexico did not excel in the area of Disaster Preparedness, the state has made some strides with regard to planning and statewide communications. The state has developed an all-hazards medical response plan, as well as a written plan for special needs patients. New Mexico also has a statewide victim tracking system, medical assistance teams, and a real-time or near real-time syndromic surveillance system.
Challenges. New Mexico faces important struggles regarding Access to Emergency Care due to factors such as lack of health insurance and workforce shortages. The state has some of the highest rates of uninsured adults and children in the country, ranks 43rd for the number of staffed inpatient beds, and 51st for its lack of pediatric specialty centers. The state is facing severe workforce shortages, with low per capita rates of neurosurgeons (ranks 49th); ear, nose, and throat specialists (45th); plastic surgeons (38th); orthopedists and hand surgeons (35th); and registered nurses (50th). The state also has a substantial need for primary care providers: an additional 149.0 full-time equivalent providers are needed to serve its population.
Similarly, New Mexico faces serious challenges regarding Public Health and Injury Prevention. The state is among the worst five states for high rates of fatal injuries, including those due to falls, homicides and suicides, and traffic fatalities. The state also has a relatively low rate of immunization among children aged 19-35 months (76.2 percent).
The Medical Liability Environment in New Mexico needs further reform. The average medical liability premiums for primary care physicians and specialists are somewhat higher than the average across the states. New Mexico has failed to enact expert witness rules that require the witness to be of the same specialty as the defendant or be licensed in the state. The state also lacks any special liability protections for providers of EMTALA-mandated emergency care.
Recommendations. New Mexico must act immediately to address hospital crowding and emergency department patient boarding. Emergency physicians in the state report that these issues have reached critical proportions throughout New Mexico. Possible contributors to these problems include a low number of staffed inpatient beds and a severe workforce shortage. As noted above, the dearth of specialists and registered nurses is among the worst in the nation, a topic that needs to be addressed at the state level to ensure access to quality care at all times.
Emergency physicians also report a serious lack of specialists willing to provide on-call services for emergency patients, as well as a decreasing number of primary care providers. Policymakers should enact medical liability reforms to encourage on-call specialists to provide EMTALA-mandated emergency care and institute broad recruitment efforts to address the severe workforce shortage in New Mexico. Increasing Medicaid reimbursement rates might also help retain the current, overwhelmed workforce as well as draw more physicians to the state.
While hospitals’ use of electronic medical records and computerized practitioner order entry helped boost the state’s grade with regard to the Quality and Patient Safety Environment, emergency physicians in the state report a need for such systems to be more thoroughly evaluated prior to implementation in order to ensure that they are efficient and effective from the clinical perspective.