A strong commitment to Public Health and Injury Prevention helped elevate Vermont’s overall ranking, countering a Medical Liability Environment that ranks among the bottom ten in the nation.
Strengths. Vermont performed well throughout the Public Health and Injury Prevention category. The state has a low percentage of traffic fatalities that are alcohol-related (33.0 percent), for which it ranked fifth among the states. In addition, the state has a universal helmet requirement for all riders on all motorized cycles. The state ranks third in funding for fall-related injury prevention ($19.32 per 1,000 people), possibly indicating a commitment to addressing the high rate of fatal fall-related injuries in the state (14.0 per 100,000 people). The state also has relatively low rates of obese adults (21.2 percent) and smokers (18.0 percent).
The state fares well in most areas of Disaster Preparedness, showing a high level of state coordination and capacity to deploy volunteers. The state has a victim tracking system, a syndromic surveillance system, and a real-time surveillance system in place for common emergency department presentations. In addition, there are statewide “just-in-time” training systems in place and a real-time notification system to notify identified health care workers of an event. The state supports medical strike teams or medical assistance teams and requires EMS and essential emergency department personnel to be compliant with the National Incident Management System.
Vermont has a number of noteworthy successes in Access to Emergency Care, as well. The state has the fifth highest Medicaid reimbursement rates for office visits in the nation (136.8 percent of the national average), which is the result of a 62.2 percent increase since 2004. Vermont also has the fourth highest rate of physicians accepting Medicare (4.5 per 100 beneficiaries). The state has the eighth lowest rate of uninsured adults (10.8 percent), which is likely due in part to the state insuring 13.6 percent of adults through Medicaid (fifth highest among the states). Finally, the state’s primary care and mental health provider capacity exceeds that of nearly all other states.
Challenges. While Vermont scores well overall in Access to Emergency Care, there also are some problems worth noting. The state has only 1.6 pediatric specialty centers per 1 million people and no accredited chest pain centers. In addition, Vermont has a relatively high level of unmet need for substance abuse treatment (9.7 percent).
Vermont’s Medical Liability Environment is among the worst in the nation. Vermont is among only 20 states that have not implemented a medical liability cap on non-economic damages and only 15 states that have not abolished joint and several liability. The state also has the third highest rate of malpractice award payments with 7.2 per 100,000 people.
While Vermont provides funding for quality improvement within the EMS system, the state has not invested in developing systems for improving the Quality and Patient Safety Environment in other areas. The state lacks a stroke system of care, as well as a PCI network or STEMI system of care. Vermont does not maintain a statewide trauma registry and has no emergency medicine residents. The state also has a relatively low percentage of hospitals with computerized practitioner order entry (9.1 percent).
Recommendations. Above all, Vermont could drastically improve the Medical Liability Environment by enacting any number of reforms. The state could implement expert witness rules requiring the witness to be of the same specialty as the defendant and pretrial screening panels to ensure more fair and reasonable outcomes in the best interest of both practitioners and patients. Vermont may also consider enacting liability protections for EMTALA-mandated emergency care in order to encourage specialists to provide on-call services for emergency patients.
In addition, Vermont would do well to institute an infrastructure for providing a stroke system of care or a PCI network or STEMI system of care and seek other opportunities to support the Quality and Patient Safety Environment in the state.