Tennessee has made notable progress in its Disaster Preparedness planning and response capacity, as well as admirable improvement to the Medical Liability Environment. However, the state is still challenged by high rates of preventable deaths and a reduced hospital capacity that are threatening Access to Emergency Care.
Tennessee's Medical Liability Environment has improved to 11th best in the nation. The state has rules requiring expert witnesses of the same specialty as the defendant and requiring case certification by an expert witness. Tennessee also placed a medical liability cap on non-economic damages in 2011, which helped to improve its rank. Malpractice awards are also offset by collateral sources received by defendants in Tennessee; this helps to reduce the overall burden of malpractice award payments. Providers in the state also benefit from below-average medical liability insurance premiums.
Tennessee scores favorably compared to other states in Disaster Preparedness. The state shares its Emergency Support Function 8 or all-hazards plan with all emergency medical services and essential hospital personnel and its medical response plan includes special-needs patients, mental health patients, and patients dependent on psychotropic medications or medications for chronic disease. The state also has a better-than-average bed surge capacity (908.7 per 1 million people) and ranks among the top 20 in the rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals.
Tennessee faces increasing barriers in Access to Emergency Care, particularly for hospital capacity. For instance, the per capita rate of emergency departments has fallen from 13.8 per 1 million people in the 2009 Report Card to 10.5 per 1 million, well below the national average. Availability of psychiatric care beds has decreased (from 33.9 to 25.6 per 100,000 people), as has availability of staffed inpatient beds (from 414.0 to 352.5 per 100,000), which is likely the result of closing two hospitals in 2011. While health insurance coverage rates are on par with the nation, Tennessee has the highest proportion of adults with insurance who report cost as a barrier to receiving needed care (10.2%).
Public Health and Injury Prevention also remains a challenge for Tennessee policymakers. The state has high rates of traffic fatalities (14.7 per 100,000 people) and bicyclist fatalities (8.7 per 100,000 cyclists), despite relatively strong seatbelt and child safety seat use laws and a law requiring helmets for all motorcycle riders. Tennessee also has some of the highest rates of both fire- or burn-related and poisoning-related deaths, which include drug overdoses (1.6 and 15.3 per 100,000 people, respectively), and the third highest infant mortality rate in the nation. Compounding this issue, the infant mortality disparity ratio (3.1) indicates that non-Hispanic Black infants have rates that are three times higher than the racial or ethnic group with the lowest rate. At the same time, however, Tennessee has the lowest cardiovascular disease disparity ratio and the lowest number of adults engaging in binge drinking (10.0%).
Tennessee's Quality and Patient Safety Environment has slipped somewhat, largely due to a failure to keep pace with other states, but also due to the addition of new indicators that better measure progress in this category. While significantly more hospitals in Tennessee have adopted computerized practitioner order entry, compared with the 2009 Report Card, the state ranks sixth worst in the nation on this measure (56.2%). The state's hospitals are below average in the proportion collecting data on race and ethnicity and primary language (52.0%) and having or planning to develop a diversity strategy (36.7%). While Tennessee requires certification from a state-approved program for 911 dispatchers who provide pre-arrival instructions, not all 911 dispatchers provide those instructions.
Tennessee's rapidly decreasing hospital capacity is a major concern with dramatic decreases in inpatient and psychiatric care beds. The state must monitor diversion and emergency department wait times and act to minimize the impact of these reductions in infrastructure. Tennessee should also work to ensure that all adults are able to afford needed preventive and emergency health care.
Tennessee must act to reduce high rates of preventable deaths and lessen the racial and ethnic disparity in infant mortality. The state should explore the underlying causes of these issues and implement outreach and evidence-based education efforts to address them.
Additionally, Tennessee could significantly improve its Quality and Patient Safety Environment by working with hospitals and encouraging them to adopt technological advances at a faster pace. Tennessee should also explore options to implement a uniform system for providing pre-arrival instructions and destination policies for stroke and ST-elevation myocardial infarction (STEMI) patients.
The state must also protect and enhance medical liability reforms and enact protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care that will encourage specialists to provide critical on-call services to emergency patients.