With an above-average percentage of insured residents and high per capita rates of emergency departments and staffed inpatient beds, West Virginia scores well in Access to Emergency Care, but substantial improvement is needed in Public Health and Injury Prevention.
Strengths. West Virginia has a number of characteristics that support Access to Emergency Care among its population. The state has the eighth highest rate of emergency departments (31.0 per 1 million people) and similarly high rankings for rates of staffed inpatient and psychiatric care beds (490.8 and 44.5 per 100,000 people, respectively). The state has lower than average rates of uninsured adults and children, as well as a relatively high percentage of adults with insurance through Medicaid. West Virginia also receives credit for collecting and reviewing data on ambulance diversion, though this is done on a regional basis, not at the state level.
West Virginia has instituted a number of important medical liability reforms, including additional liability protections for EMTALA-mandated emergency care, case certification by an expert witness, and the requirement that expert witnesses be of the same specialty as the defendant. In addition, the state has the eighth lowest average malpractice award which is significantly lower than the average across the states ($209,564 versus $285,218, respectively).
West Virginia also has shown some commitment toward improving its Quality and Patient Safety Environment through developing a stroke system of care and a PCI network or STEMI system of care, as well as maintaining a statewide trauma registry. The state also provides funding for a state EMS medical director position and quality improvement within the EMS system.
Challenges. Public Health and Injury Prevention indicators pose the greatest challenge to the state. West Virginia ranks 41st in the nation in infant mortality (8.1 deaths per 1,000 live births) and 50th with regard to both obesity and smoking: 31.0 percent of adults are obese and 25.7 percent are current smokers. In addition, the state has high rates of fatal occupational injuries (81.6 per 1 million workers) and traffic fatalities (22.6 per 100,000 people).
While faring well overall with regard to Access to Emergency Care, West Virginia, along with many states, is facing a workforce shortage. The state has relatively low rates of orthopedists and hand surgeons (7.8 per 100,000 people) and plastic surgeons (1.5 per 100,000). There also are only 2.4 physicians accepting Medicare per 100 beneficiaries, which may pose particular barriers for the elderly population in accessing needed medical care. In addition, only 71.0 percent of the state’s population is within 60 minutes of a Level I or II trauma center, despite the relatively high rate of Level I or II trauma centers in the state (3.3 per 1 million people).
West Virginia has taken steps to prepare for a disaster event, but there are some aspects of Disaster Preparedness in which the state is lacking. The state has no verified burn centers, and only 2.2 burn unit beds per 1 million people. West Virginia does not have a statewide real-time or near real-time syndromic surveillance system. The state’s score also was affected by the lack of written plans for special needs patients, as well as the lack of written plans to supply medications for chronic conditions and dialysis for patients in the event of a disaster.
Recommendations. West Virginia needs to redouble its efforts to promote healthier lifestyles among its population, improve traffic safety, and reduce the number of work-related fatalities.
The state could improve the Quality and Patient Safety Environment by instituting mechanisms to monitor the quality of hospital care statewide. This could be accomplished through mandatory quality reporting requirements and requiring adverse event or hospital-based infections reporting.
While West Virginia has enacted considerable medical liability reforms, the state could still improve the Medical Liability Environment in a number of ways. The state could implement mandatory pretrial screening panels and require or provide for expert witnesses to be licensed in the state. The state also could institute further reforms, including reducing the maximum medical liability cap on non-economic damages and requiring periodic payment of awards.