AMERICA’S EMERGENCY
CARE ENVIRONMENT

Kansas

Category Grades
2009
RankGrade
 2014
RankGrade
Overall:
 8C+ 16C
Access to Emergency Care:
 7B- 14C-
Quality/Patient Safety:
 38D+ 44F
Medical Liability:
 3A 4A-
Public Health/ Injury Prevention:
 22C 18C+
Disaster Preparedness:
 37D+ 26C-


With its strong Medical Liability Environment, Kansas enjoys relatively solid access to health care providers and hospital facilities. However, the state should concentrate on improvements to the Quality and Patient Safety Environment to ensure that its citizens are receiving uniform care that will enhance outcomes in emergencies.

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Strengths

Kansas has the fourth best Medical Liability Environment in the nation, boasting strong protections for health care providers. The state has the seventh lowest average malpractice award payments ($154,127) and well-below-average medical liability insurance premiums for both primary care physicians ($8,610) and specialists ($37,651). Kansas has enacted many reforms that discourage frivolous lawsuits, including voluntary pretrial screening panels whose findings are admissible as evidence and rules on expert witness qualifications. The state's $250,000 cap on non-economic damages was also recently upheld by the state's Supreme Court.

While declining somewhat in Access to Emergency Care since 2009, Kansas continues to enjoy a solid health care workforce with better than average numbers of orthopedists and hand surgeons; plastic surgeons; and registered nurses. The state fared well for Access to Emergency Care facilities, with the third highest per capita rate of emergency departments (ED) (44.7 per 1 million people) and the second lowest ED wait times (180 minutes from ED arrival to departure for admitted patients), despite having one of the lowest rates of emergency physicians in the nation (8.3 per 100,000 people). Kansas has the third lowest hospital occupancy rate in the nation and ranks among the top 10 states in access to accredited chest pain centers and pediatric specialty centers.

Kansas has made several improvements in Disaster Preparedness since the last Report Card. The state's medical response plan now includes special needs patients, patients dependent on medication for chronic conditions, and patients dependent on dialysis. Public health and emergency physician input is included during an Emergency Support Function 8 response, and emergency physicians have input into state disaster planning. In addition, Kansas has a strong infrastructure for a disaster or mass casualty event, with high rates of burn unit beds and intensive care unit beds.

Challenges

Kansas's poor grade in Quality and Patient Safety Environment is due to a lack of guidelines and protocols for its emergency medical services (EMS) system. For instance, Kansas lacks a uniform system for providing pre-arrival instructions that could aid in providing life-saving care in an emergency and does not have state field triage protocols. Outside of the major metropolitan areas, Kansas does not have triage and destination policies in place for trauma, ST-elevation myocardial infarction (STEMI), or stroke patients. The state has not dedicated funding for quality improvement within the EMS system and lacks a funded state EMS medical director to oversee quality improvement and patient safety in the state.

Although the state performed better than average in Public Health and Injury Prevention, Kansas has a few concerning indicators. The state has a very high rate of fatal occupational injuries (56.1 per 1 million workers), which is only slightly lower than reported in the previous Report Card, and has no funding sources specifically dedicated for occupational injury prevention. Kansas also has a high rate of traffic fatalities, and lacks a ban on handheld cellphone use while driving.

Recommendations

Kansas must invest in quality improvement efforts that will benefit its population, such as instituting a uniform system for providing pre-arrival instructions. The state must consider funding a state EMS medical director position to oversee development and implementation of field triage guidelines and destination policies for stroke, STEMI, and trauma patients to take full advantage of the state's relative abundance of trauma centers and chest pain centers.

The state must continue to support and build on the success it has realized in establishing its first emergency residency program in order to increase the number of emergency physicians, as well as board-certified emergency physicians, practicing in the state. Expanding the size of its residency program would be a significant step in this direction. Kansas also must work to address its high rates of uninsured and underinsured children (9.4 and 21.1%, respectively) to ensure all are able to access care when they need it.

Kansas should continue to improve its Disaster Preparedness by increasing the number of health care providers registered with the Emergency System for Advance Registration of Volunteer Health Professionals. The state has a very low rate of physicians registered (5.9 per 1 million people) and only an average rate of nurses registered (189.5 per 1 million).

Access to Emergency Care

Title 2009
Report Card		 2014
Report Card
Board-certified emergency physicians per 100,000 pop 7.1 7.9
Emergency physicians per 100,000 pop 7.9 8.3
Neurosurgeons per 100,000 pop 1.3 1.5
Orthopedists and hand surgeon specialists per 100,000 pop 9.0 9.9
Plastic surgeons per 100,000 pop 2.1 2.4
ENT specialists per 100,000 pop 3.2 3.4
Registered nurses per 100,000 pop 873.4 981.7
Percent of children able to see provider 96.3
Level I or II trauma centers per 1M pop 1.8 2.1
Percent of population within 60 minutes of Level I or II trauma center 75.4 78.7
Accredited chest pain centers per 1M pop 2.5 5.2
Percent of population with an unmet need for substance abuse treatment 8.8 8.7
Pediatric specialty centers per 1M pop 4.7 5.2
Medicaid fee levels for office visits as a percent of the national average 109.4 89.0
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 54.0 0.0
Percent of adults with no health insurance 14.0 14.9
Percent of adults underinsured 6.7
Percent of children with no health insurance 7.3 9.4
Percent of children underinsured 21.1
Percent of adults with Medicaid 5.7 7.1
Hospital closures in 2006/2011 1 0
Staffed inpatient beds per 100,000 pop 446.0 418.3
Hospital occupancy rate per 100 staffed beds 57.2 56.5
Psychiatric care beds per 100,000 pop 46.6 39.0
Median time from ED arrival to ED departure for admitted ED patients 180
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card		 2014
Report Card
Per capita federal disaster preparedness funds $7.93 $6.12
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 NR 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 NO
Special needs patients included in medical response plan NO YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
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 NO
Statewide real-time or near real-time syndromic surveillance system NO NO
Real-time surveillance system in place for common ED presentations NR NO
Bed surge capacity per 1M pop 1,489.6 612.6
ICU beds per 1M pop 358.9 335.8
Burn unit beds per 1M pop 8.3 9.7
Verified burn centers per 1M pop 0.360230937 0.7
Physicians registered in ESAR-VHP per 1M pop 0.0 5.9
Nurses registered in ESAR-VHP per 1M pop 16.9 189.5
Behavioral health professionals registered in ESAR-VHP per 1M pop 37.8
Strike teams or medical assistance teams NO YES
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 41.3 37.9

Medical Liability Environment

Title 2009
Report Card		 2014
Report Card
Lawyers per 10,000 pop 13.4 12.9
Lawyers per physician 0.6 0.5
Lawyers per emergency physician 16.8 15.6
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 1
Malpractice award payments per 100,000 pop 2.1 3.1
Average malpractice award payments $181,676 $154,127
National Practitioner Databank reports per 1,000 physicians 32.2 26.7
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund YES YES
Number of insurers writing medical liability policies per 1,000 physicians 9.1 10.7
Average medical liability insurance premiums for primary care physicians $10,368 $8,610
Average medical liability insurance premiums for specialists $46,060 $37,651
Presence of pretrial screening panels VOLUNTARY VOLUNTARY
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion AT JUDGE'S OR COURT'S DESCRETION AT COURT'S DESCRETION
Medical liability cap on non-economic damages $250,000 $250,000
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 NO
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant YES YES
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card		 2014
Report Card
Bicyclist fatalities per 100,000 cyclists 4.2
Pedestrian fatalities per 100,000 pedestrians 2.6
Percent of traffic fatalities alcohol-related 36.0 24.0
Percent of front occupants using restraints 75.0 82.9
Child safety seat/seat belt legislation - score out of a possible 10 points 5 8
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 79.0 81.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72.5 67.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 69.5 70.8
Fatal occupational injuries per 1M workers 60.3 56.1
Homicides and suicides (non-motor vehicle)(per 100,000) 17.0 17.2
Unintentional fall-related fatal injuries (per 100,000) 7.6 11.2
Fire/burn related fatal injuries (per 100,000) 1.3 1.1
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 7.6
Total injury prevention funds per 1,000 persons $533.86 $415.63
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 7.4 6.2
Percentage of adults who binge drink 15.4 17.0
Percentage of adults who currently smoke 20.0 22.0
Percentage of adult population who are obese (BMI > 30.0) 25.9 29.6
Percentage of children who are obese 14.2
Cardiovascular disease disparity ratio 2.1
HIV diagnosis disparity ratio 8.4
Infant mortality disparity ratio 2.6

Quality & Patient Safety

Title 2009
Report Card		 2014
Report Card
Funding for quality improvement within the EMS system NO NO
Funded state EMS medical director NO NO
Emergency medicine residents per 1M pop 0.0 6.2
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 99.1 100.0
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols NO PROTOCOLS
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 YES 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 NO
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 6.8 63.8
% of hospitals with electronic medical records 20.2 75.9
% of patients with AMI given PCI within 90 minutes of arrival 58 95
Median time to transfer to another facility for acute coronary intervention 66
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 74.1
% of hospitals with or planning to develop a diversity strategy or plan 39.2

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