Vermont's overall score has declined, largely due to a lack of statewide planning and policies in Disaster Preparedness, as well as declining hospital capacity. The state continues, however, to invest in and improve its Quality and Patient Safety Environment.
Vermont has improved its Quality and Patient Safety Environment by supporting measures to improve care and emergency response capabilities statewide. The state has continued funding for an emergency medical services (EMS) medical director, as well as quality improvement within the EMS system, and has worked to implement stroke and ST-elevation myocardial infarction (STEMI) systems of care. Vermont leads the nation in the time that it takes to transfer patients with chest pain or acute coronary intervention to another facility (28 minutes).
Vermont continues to fare well in Public Health and Injury Prevention, with high immunization rates and moderate health risk factors. The state boasts high vaccination rates for older adults, with 65.4% having received an annual influenza vaccination and 74.3% having ever received the pneumococcal vaccine. Vermont also has one of the lowest infant mortality rates (4.2 deaths per 1,000 live births) and below-average proportions of adults and children who are obese (25.4% and 11.3%, respectively).
In Access to Emergency Care, Vermont performs exceptionally in reducing financial barriers to care, boasting some of the highest rates of health insurance coverage for adults and children in the nation. The state has relatively high Medicaid fee levels for office visits (117.1% of the national average). Vermont also has adequate access to providers, including primary care providers, many types of specialists, and emergency physicians.
Vermont fares poorly overall in Access to Emergency Care because of the lack of specialty centers and declining hospital capacity. The state has no accredited chest pain centers and ranks second to last for the number of pediatric specialty centers (1.6 per 1 million people). Only 78.5% of the population is within 60 minutes of a level I or II trauma center, compared to an average of 82.1% nationally. Vermont has seen an overall decline since the previous Report Card in staffed inpatient beds, emergency departments (ED), and psychiatric care beds and an increase in the hospital occupancy rate. As such, the state has higher-than-average ED wait times: 295 minutes from ED arrival to ED departure for admitted patients.
While Vermont's Medical Liability Environment ranking has improved slightly since the 2009 Report Card, this is due only to minor improvements and the addition of apology inadmissibility laws, which is the only measured reform that Vermont is credited with having. The state lacks any expert witness rules requiring experts to practice in the same specialty as the defendant or to be licensed to practice in the state, rules that can prevent unfounded cases from proceeding. The state has also failed to enact special liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Vermont has seen an increase in its average malpractice award payment yet has no reforms in place that would help to rein in excessive payments.
Vermont's Disaster Preparedness grade declined significantly, due in part to the addition of new indicators and because of a lack of statewide policies and a low level of volunteer capacity compared to other states. Vermont's medical response plan lacks provisions for patients dependent on dialysis or medication for chronic diseases. It has no mutual aid agreements in place with behavioral health providers to provide services during a disaster and no behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals. Vermont also lacks strike teams or medical assistance teams to provide assistance during a disaster or mass casualty event.
Vermont policymakers must seriously consider the impact of such a poor Medical Liability Environment on both providers and patients. While the state has an adequate supply of many types of providers, day in and day out, emergency physicians and on-call specialists provide care to high-risk patients and must make quick decisions with little or no knowledge of their medical history. The state must support providers of EMTALA-mandated care by offering additional liability protections that recognize those risks and that at least require clear and convincing evidence of negligence in medical liability cases. Vermont could also consider pretrial screening panels and requiring that expert witnesses be of the same specialty as the defendant.
Vermont should continue to build upon existing improvements to the Quality and Patient Safety Environment by developing destination policies for stroke and STEMI patients that would allow EMS providers to bypass local hospitals for medical specialty centers when appropriate. Finally, Vermont must work with stakeholders to increase its hospital capacity and reduce the long ED wait times, which can lead to poor patient outcomes.