Category Grades
19C 11C
Access to Emergency Care:
9B- 13C-
Quality/Patient Safety:
42D 27C
Medical Liability:
32D 27C
Public Health/ Injury Prevention:
12B 14B
Disaster Preparedness:
23C+ 14C+

Iowa ranks 11th in the nation for its overall emergency care environment, with a strong commitment to Public Health and Injury Prevention and notable improvements in its Disaster Preparedness and Quality and Patient Safety Environment. However, the state faces critical health care workforce shortages and must continue to improve the Medical Liability Environment.

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Iowa's best performance was in Public Health and Injury Prevention. Iowa supports relatively high injury prevention funding ($588.66 per 1,000 people) and enjoys low fatal injury rates. For instance, it has the eighth lowest rate of homicide and suicide (14.2 per 100,000 people). For motor vehicle accidents, it has a very low rate of traffic fatalities that are alcohol-related (27%), and one of the lowest pedestrian fatality rates in the country (1.7 per 100,000 pedestrians). Iowa fares well with immunizations, ranking second in the nation for influenza vaccination among older adults (70.2%). It has an exceedingly low infant mortality rate (4.9 per 1,000 live births) and a below-average rate of childhood obesity (13.6%).

Iowa has made notable improvements to its Disaster Preparedness practices and policies since the last Report Card, more than doubling bed surge capacity (1,742.6 beds per 1 million people) to the third highest in the country, as well as incorporating patients dependent on medication for chronic conditions into its medical response plan. It also has the fifth highest percentage of nurses who have received disaster training (47.2%), and it has substantially increased the per capita rates of physicians, nurses, and behavioral health providers registered in the Emergency System for Advance Registration of Volunteer Health Professionals (ESARVHP), though these rates still fall well below the national average.


Although Iowa has a strong showing in many areas of Access to Emergency Care, the state is facing a severe shortage of health care providers. It has the lowest per capita rate of emergency physicians in the nation, (6.8 per 100,000 people). Iowa also lacks neurosurgeons, plastic surgeons, and orthopedists and hand surgeons, ranking almost last in the nation for all these specialties. It is below average in terms of access to physicians accepting Medicare fee-for-service patients, a trend that is likely to worsen as the population ages. The state's Medicaid fee levels have declined by 1.2% since 2007, a troubling trend in light of the state's decision to expand Medicaid under the Affordable Care Act.

Iowa has developed a percutaneous coronary intervention network or a ST-elevation myocardial infarction (STEMI) system of care and increased the number of emergency medicine residents since the last Report Card, which has helped to improve its overall standing in Quality and Patient Safety Environment. However, the state lacks important provisions, including triage and destination policies for stroke and STEMI patients that allow emergency medical services (EMS) to bypass local hospitals for medical specialty centers. Iowans also could benefit from the implementation of a uniform system for providing pre-arrival instructions, which could help to administer life-saving care while awaiting EMS arrival.

Iowa's Medical Liability Environment ranks squarely in the middle of the pack. Although Iowa has relatively low average medical liability insurance premiums for primary care physicians ($7,280) and specialists ($32,184), it has few protections in place for providers, including those responsible for administering emergency care.


Limited access to specialists and other health care providers continues to burden the Iowa health care system. The state must work to attract and retain a skilled health care workforce to handle the growing heath care needs of its population. Increasing Medicaid fee levels to meet or exceed the national average may help address the problem, as would a more favorable Medical Liability Environment.

Iowa should enact liability protections for providers administering care mandated by the Emergency Medical Treatment and Labor Act: care to high-risk patients when the provider does not have a preexisting patient relationship and has little to no knowledge of a patient's medical history. Additionally, pretrial screening panels or provisions for case certification could help discourage frivolous lawsuits, and a medical liability cap on non-economic damages could prevent excessive verdicts.

Despite its stellar score in Public Health and Injury Prevention, Iowa has one of the higher rates of fatal occupational injuries (48.5 per 1 million workers). Dedication of funds specifically for occupational injury prevention may be useful in addressing this concern. Iowa also needs to reach out to medical professionals and increase registration in ESAR-VHP to increase the state's ability to respond quickly to a major disaster or mass casualty event.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 4.0 4.3
Emergency physicians per 100,000 pop 6.3 6.8
Neurosurgeons per 100,000 pop 1.1 1.3
Orthopedists and hand surgeon specialists per 100,000 pop 7.8 7.2
Plastic surgeons per 100,000 pop 1.2 1.1
ENT specialists per 100,000 pop 3.5 3.8
Registered nurses per 100,000 pop 994.1 1,084.5
Percent of children able to see provider 97.6
Level I or II trauma centers per 1M pop 2.3 2.0
Percent of population within 60 minutes of Level I or II trauma center 71.0 80.1
Accredited chest pain centers per 1M pop 0.7 2.3
Percent of population with an unmet need for substance abuse treatment 8.8 9.3
Pediatric specialty centers per 1M pop 6.4 6.2
Medicaid fee levels for office visits as a percent of the national average 116.3 93.5
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 3 -1.2
Percent of adults with no health insurance 11.9 11.6
Percent of adults underinsured 5.5
Percent of children with no health insurance 6.3 4.9
Percent of children underinsured 15.9
Percent of adults with Medicaid 9.7 10.4
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 377.3 344.4
Hospital occupancy rate per 100 staffed beds 59.9 57.8
Psychiatric care beds per 100,000 pop 33.5 28.0
Median time from ED arrival to ED departure for admitted ED patients 198
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.62 $5.90
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO NO
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system YES YES
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations NO NO
Bed surge capacity per 1M pop 649.9 1,742.6
ICU beds per 1M pop 291.3 272.6
Burn unit beds per 1M pop 5.4 5.2
Verified burn centers per 1M pop 0.334666869 0.3
Physicians registered in ESAR-VHP per 1M pop 0.0 10.1
Nurses registered in ESAR-VHP per 1M pop 0.0 113.2
Behavioral health professionals registered in ESAR-VHP per 1M pop 4.9
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NR
Percent of RNs that received emergency training 40.3 47.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 9.2 9.7
Lawyers per physician 0.4 0.4
Lawyers per emergency physician 14.7 14.2
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 1
Malpractice award payments per 100,000 pop 2.1 1.7
Average malpractice award payments $208,061 $256,226
National Practitioner Databank reports per 1,000 physicians 22.7 28.2
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 9.4 11.5
Average medical liability insurance premiums for primary care physicians $7,720 $7,280
Average medical liability insurance premiums for specialists $34,907 $32,184
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion AT JUDGE'S OR COURT'S DESCRETION UPON REQUEST
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant NO NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 3.7
Pedestrian fatalities per 100,000 pedestrians 1.7
Percent of traffic fatalities alcohol-related 34.0 27.0
Percent of front occupants using restraints 91.3 93.5
Child safety seat/seat belt legislation - score out of a possible 10 points 5 5
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 1
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 85.0 78.9
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 73.6 70.2
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 71.1 70.9
Fatal occupational injuries per 1M workers 50.5 48.5
Homicides and suicides (non-motor vehicle)(per 100,000) 12.7 14.2
Unintentional fall-related fatal injuries (per 100,000) 11.3 12.9
Fire/burn related fatal injuries (per 100,000) 1.1 1.1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 6.7
Total injury prevention funds per 1,000 persons $262.18 $588.66
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 5.3 4.9
Percentage of adults who binge drink 20.6 23.1
Percentage of adults who currently smoke 21.4 20.4
Percentage of adult population who are obese (BMI > 30.0) 25.7 29.0
Percentage of children who are obese 13.6
Cardiovascular disease disparity ratio 1.4
HIV diagnosis disparity ratio 8.5
Infant mortality disparity ratio 2.5

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director NO NO
Emergency medicine residents per 1M pop 6.4 7.8
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 100.0 100.0
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2006)
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients NO
State has or is working on a PCI network or a STEMI system of care NO YES
State has triage and destination policy in place for STEMI patients NO
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 14.6 85.1
% of hospitals with electronic medical records 29.9 93.4
% of patients with AMI given PCI within 90 minutes of arrival 72 94
Median time to transfer to another facility for acute coronary intervention 59
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 85.7
% of hospitals with or planning to develop a diversity strategy or plan 54.0

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