Pennsylvania has made great strides in Access to Emergency Care since the 2009 Report Card, moving from 23rd to 2nd place; however, unmet liability protections for emergency care providers, uncertainty regarding the phase-out of the state's liability insurance program, and declining performance in Disaster Preparedness continue to threaten the emergency care environment.
Pennsylvania's Access to Emergency Care has improved greatly since the 2009 Report Card. While a variety of sources indicate a mixed picture of the current and future adequacy of the state's supply of health care providers, data in this report indicate below-average rates of health professional shortages, though shortages persist among some specialties. Reports of an aging physician workforce could exacerbate those shortages as the percentage of patients with insurance, which has already increased since the 2009 Report Card, continues to grow under the Affordable Care Act. Also contributing to the improvement in this category was a 79.7% increase in Medicaid fee levels for office visits from 2007 to 2012, although the state's fee levels are still only 80% of the national average. Pennsylvania has a relatively low proportion of adults with an unmet need for substance abuse treatment (7.9%) and below-average rates of underinsurance for both adults (7.4%) and children (15.3%).
Pennsylvania continues to rank among the top in the nation with regard to the Quality and Patient Safety Environment, having statewide systems and policies in place for ST-elevation myocardial infarction, stroke, and trauma patients. It also supports a large number of emergency medicine residents (48.6 per 1 million population), representing the fourth highest rate in the nation.
While some aspects of the state's Medical Liability Environment have improved with the elimination of venue shopping, the adoption of a certificate of merit, and expert witness qualifications, Pennsylvania has not kept up with improvements seen in other states. It still has some of the highest average medical liability insurance premiums for primary care physicians ($20,890) and specialists ($88,865) in the nation. The state also lacks additional protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Finally, the eventual statutorily mandated phase-out of the state's Medical Care Availability and Reduction of Error Act (MCARE) liability insurance program, which could require physicians and hospitals to assume the program's $1.3 billion unfunded liability, continues to cast a dark cloud over providers.
Pennsylvania continues to face challenges with regard to Public Health and Injury Prevention, falling in the bottom third of states with regard to infant mortality rates (7.3 deaths per 1,000 live births) and unintentional poisoning-related deaths (13.4 deaths per 100,000 people). The state has also failed to pass smoking bans in bars and has only limited bans in restaurants, despite having above average rates of smoking among adults (22.4%).
Pennsylvania's grade for Disaster Preparedness was heavily affected by declines in bed surge capacity, intensive care unit beds, burn unit beds, and the proportion of nurses who reported receiving Disaster Preparedness training, compared to the 2009 Report Card. In addition, while Pennsylvania reported significantly higher rates of physicians and nurses registered in the Emergency System for Volunteer Health Professionals than in 2009, the state did not keep pace with the nation, now reporting rates less than half the national averages.
The state must work to adopt a ìclear and convincingî standard for EMTALA-related care, which would require that evidence be provided to show that emergency care personnel's actions were grossly negligent under the given circumstances. Additionally, Pennsylvania needs to phase out the MCARE program in a way that will not negatively affect the state's already high liability premiums.
While Pennsylvania has operationalized a prescription drug monitoring program, the state does not monitor drug schedules II to V and has not implemented a system for real-time access of this information by providers. Doing so would further strengthen the state's Quality and Patient Safety Environment.
Boarding and crowding in the emergency department (ED) and the negative effects that these issues have on patient care and outcomes continue to be major concerns in Pennsylvania, despite its improvement in Access to Emergency Care overall. While state reports indicate that the number of ED visits have increased, Pennsylvania has seen a decrease in the number of EDs, staffed inpatient beds, and psychiatric care beds per population and continues to have a higher-than-average hospital occupancy rate. The commonwealth should adopt a statewide psychiatric bed registry and work closely with hospitals to minimize boarding of admitted patients in EDs.