Kentucky Earns a D+, Ranks 44th in the Nation, in Report Card for Its
Lack of Support for Emergency Patients
Failing Grades in Quality & Patient Safety, Medical Liability Environment
Place Kentucky Near Bottom of National Rankings
Louisville, KY—With failing grades in the individual categories of Quality & Patient Environment and Medical Liability Environment, Kentucky received an overall grade of D+ and ranked 44th nationally on this year’s American College of Emergency Physicians National Report Card on the State of Emergency Medicine. The Report Card comes at the time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.
Kentucky ranked 49th in the category of Quality & Patient Safety Environment. The state’s failing grade in this area was due to a lack of funding to make quality improvements to its EMS system and a lack of initiatives to make those improvements. Further, the state has no uniform system for providing pre-arrival instructions and no requirements for reporting hospital-based infections and adverse events. Kentucky also scored poorly with a ranking of 46th for the percentage of patients with acute myocardial infarction who receive angioplasty within 90 minutes of arrival.
“The state must address its failing grade in the Quality & Patient Safety Environment category by providing funding for quality improvement of the EMS system and developing a uniform system for pre-arrival instructions as first steps in the process,” said Christopher R. Pund, MD, president of the Kentucky Chapter of ACEP. “Kentucky cannot afford to fail its patients.”
While there has been an effort to pass medical liability reforms, they have all stalled in the Kentucky legislature. None of the suggested actions put forth by the 2006 ACEP Report Card have been enacted and Kentucky remains near the bottom of the national ranking at 47th in the category of Medical Liability Environment with another sobering grade of F. As a result, the state continues to lack a medical liability cap on non-economic damages, liability protections for EMTALA-mandated emergency care, requirements for case certification by an expert witness, or expert witness rules requiring the witness to be of the same specialty as the defendant.
“Kentucky must find a way to improve its poor medial liability environment so we no longer have a shortage of specialists in the state,” says Dr. Pund. “On-call specialist coverage for emergency patients is a problem. Enacting special liability protections for EMTALA-mandated emergency care would be a great way to alleviate this problem by attracting and retaining more physicians who practice in our state.”
Kentucky received yet another disappointing grade, this time a D and a 35th place ranking, in the category of Public Health & Injury Prevention due to a failure to educate and prevent unhealthy lifestyle choices and accidental deaths. Kentucky has one of the most obese populations, a disproportionately high rate of unintentional fatal injuries and the highest number of smokers in the nation (28.5 percent). It also has one of the lowest rates of seatbelt usage, a higher than average traffic fatality rate and no motorcycle helmet law.
In the category of Access to Emergency Care, Kentucky received a grade of C and a national ranking of 19th. The positives in this category included a low daily hospital occupancy rate (63.2 per 100 staffed beds), a high rate of staffed inpatient beds (401.2 per 100,000) and high numbers of pediatric specialty centers (4.0 per 1 million people). Additionally, Kentucky also has a relatively high number of accredited chest pain centers. One great concern is Kentucky's below average per capita rate of neurosurgeons, orthopedists and ENT specialists, which is likely the result of the poor Medical Liability Environment.
Kentucky's best mark in this year's Report Card was in the category of Disaster Preparedness with a national ranking of 28th and an above-average grade of C+. In the event of a wide-scale disaster, Kentucky has implemented a number of measures to advance the state's readiness. The state has an all-hazards medical response plan and a statewide system for “just-in-time” training during a disaster, as well as statewide patient and victim tracking systems. Kentucky has also worked to register physicians and nurses with the state-based Emergency System for Advance Registration of Volunteer Health Professionals, for which it ranks 19th and 6th in the nation, respectively.
The nation’s failure to support emergency patients resulted in a C- for the country overall. Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-. The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.
“The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP. “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform. We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are a health care safety net for us all.”
The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card.
The five Report Card categories (and weightings) are: Access to Emergency Care (30 percent), Quality and Patient Safety Environment (20 percent), Medical Liability Environment (20 percent), Public Health and Injury Prevention (15 percent) and Disaster Preparedness (15 percent).
The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of the Anthem Blue Cross and Blue Shield Foundation and the Robert Wood Johnson Foundation.
The Kentucky Chapter of ACEP is a state chapter of the American College of Emergency Physicians, a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
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