Category Grades
44D+ 47D
Access to Emergency Care:
19C 12C
Quality/Patient Safety:
49F 43F
Medical Liability:
47F 48F
Public Health/ Injury Prevention:
35D 34D
Disaster Preparedness:
28C+ 33D

With ample medical facilities and high rates of insured children, Kentucky has improved somewhat in Access to Emergency Care. However, the state's poor Medical Liability Environment and lack of provisions to improve the Quality and Patient Safety Environment bring the state's overall emergency care environment to fifth worst in the nation.

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Kentucky ranks 12th in the nation in Access to Emergency Care, largely due to improvements in key measures since the previous Report Card. Kentucky's citizens enjoy increasing access to accredited chest pain centers (5.5 per 1 million people) and above-average per capita rates of pediatric specialty centers (3.9 per 1 million people). Access to behavioral health care is also relatively strong, with a low rate of unmet need for substance abuse treatment (7.3%) and one of the nation's highest per capita rates of psychiatric care beds (34.5 per 100,000 people).

Kentucky has also increased Medicaid fee levels for office visits by 58.0% since 2007, although those payments continue to lag behind the national average. Kentucky also has some bright spots in Disaster Preparedness, including the fifth highest bed surge capacity (1,707.8 per 1 million people). The state's Disaster Preparedness plans are relatively comprehensive, and statewide systems are in place, such as a just-in-time training system and a statewide medical communication system with one layer of redundancy.


Kentucky continues to suffer from a poor Medical Liability Environment, having made no progress since the previous Report Card and failing to enact even the most basic reforms, such as apology inadmissibility laws that would allow providers to apologize to patients and their families for unfortunate circumstances without fear that it will be used against them as evidence in court. The state also lacks pretrial screening panels and a process for case certification by expert witnesses.

Kentucky lags in its Quality and Patient Safety Environment. Although it does have a funded state EMS medical director, Kentucky lacks some state-level protocols that can ensure that emergency patients receive life-saving care, such as a uniform system for providing pre-arrival instructions, and triage and destination policies for ST-elevation myocardial infarction (STEMI) patients. The state does not require adverse event reporting, which can help track and prevent medication errors and unfavorable patient outcomes.

In the area of Public Health and Injury Prevention, Kentucky has some bright spots, such as the fourth highest rate of childhood immunizations and above-average rates of influenza vaccinations for older adults. These indicators are tempered by high health risk factors. Kentucky has the highest rate of adult smoking in the nation (29.0%), and weak antismoking laws increase opportunities for secondhand smoke exposure. Kentucky also has among the highest rates of adult and child obesity in the country (30.4 and 19.7%, respectively). Additionally, a high cardiovascular disease disparity ratio indicates that some racial and ethnic groups lack access to proper prevention and medical care.


Kentucky must work to improve its failing grade in Quality and Patient Safety by continuing to develop and improve statewide emergency response policies. The state should investigate implementing statewide policies to improve and standardize care, including destination policies for STEMI and stroke patients, which could benefit from the state's relatively high rate of accredited chest pain centers.

Kentucky is long overdue for improving its Medical Liability Environment. The state must work to implement expert witness rules that require experts to be of the same specialty as the defendant and licensed to practice medicine in the state. Requiring case certification by expert witnesses may also reduce the number of frivolous malpractice cases brought to court, alleviating this burden on providers, patients, and the court system as a whole. Kentucky should also consider implementing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), which requires physicians to provide lifesaving care, often without a preexisting patient relationship and little to no knowledge of a patient's medical history.

While Kentucky's decision to expand Medicaid under the Patient Protection and Affordable Care Act undoubtedly will help increase health insurance coverage among adults, the state must continue to increase reimbursements for providers accepting Medicaid. While Kentucky has increased fee levels since 2007, these rates still fall below the national average and may not be sufficient to attract and retain primary care providers needed to meet increasing health care demands.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 6.1 7.0
Emergency physicians per 100,000 pop 10.1 11.7
Neurosurgeons per 100,000 pop 1.7 1.9
Orthopedists and hand surgeon specialists per 100,000 pop 8.4 8.7
Plastic surgeons per 100,000 pop 2.1 2.2
ENT specialists per 100,000 pop 2.9 3.0
Registered nurses per 100,000 pop 930.4 1,026.1
Percent of children able to see provider 96.5
Level I or II trauma centers per 1M pop 0.5 0.5
Percent of population within 60 minutes of Level I or II trauma center 75.3 90.1
Accredited chest pain centers per 1M pop 3.5 5.5
Percent of population with an unmet need for substance abuse treatment 7.8 7.3
Pediatric specialty centers per 1M pop 4.0 3.9
Medicaid fee levels for office visits as a percent of the national average 72.4 93.0
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 0 58.0
Percent of adults with no health insurance 17.5 17.4
Percent of adults underinsured 9.8
Percent of children with no health insurance 9.7 4.6
Percent of children underinsured 17.2
Percent of adults with Medicaid 9.6 10.8
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 401.2 376.9
Hospital occupancy rate per 100 staffed beds 63.2 60.9
Psychiatric care beds per 100,000 pop 24.6 34.5
Median time from ED arrival to ED departure for admitted ED patients 244
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.49 $5.03
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, NO
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 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 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 731.8 1,707.8
ICU beds per 1M pop 314.0 285.1
Burn unit beds per 1M pop 4.5 3.0
Verified burn centers per 1M pop 0.0 0.0
Physicians registered in ESAR-VHP per 1M pop 21.2 11.9
Nurses registered in ESAR-VHP per 1M pop 340.9 209.6
Behavioral health professionals registered in ESAR-VHP per 1M pop 14.8
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, YES NO, YES
Percent of RNs that received emergency training 42.3 39.8

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 10.9 12.3
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 10.7 10.5
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1.7 2.4
Average malpractice award payments $259,180 $259,211
National Practitioner Databank reports per 1,000 physicians 26.2 41.9
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 6.8 8.9
Average medical liability insurance premiums for primary care physicians $12,465 $12,089
Average medical liability insurance premiums for specialists $61,405 $52,883
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 AT COURT'S DESCRETION
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished PARTIALLY 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 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 4.7
Pedestrian fatalities per 100,000 pedestrians 5.0
Percent of traffic fatalities alcohol-related 30.0 28.0
Percent of front occupants using restraints 71.8 82.2
Child safety seat/seat belt legislation - score out of a possible 10 points 7 7
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 1
Percentage of children aged 19-35 months who are immunized 84 82.4
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 66 64.2
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 64.6 70.0
Fatal occupational injuries per 1M workers 72.1 36.6
Homicides and suicides (non-motor vehicle)(per 100,000) 18.9 19.2
Unintentional fall-related fatal injuries (per 100,000) 5.0 6.6
Fire/burn related fatal injuries (per 100,000) 2.0 1.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.8 0.5
Rate of unintentional poisoning-related deaths (per 100,000) 21.9
Total injury prevention funds per 1,000 persons $527.23 $221.51
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding YES
Anti-smoking legislation score - score out of a possible 3 points 0
Infant mortality rate per 1,000 live births 6.6 6.8
Percentage of adults who binge drink 8.6 16.1
Percentage of adults who currently smoke 28.5 29.0
Percentage of adult population who are obese (BMI > 30.0) 28.0 30.4
Percentage of children who are obese 19.7
Cardiovascular disease disparity ratio 3.5
HIV diagnosis disparity ratio 8.3
Infant mortality disparity ratio 2.5

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO NO
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 12.0 12.8
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 85.1 96.7
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 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) 3
% of hospitals with computerized practitioner order entry 12.1 67.9
% of hospitals with electronic medical records 30.0 92.7
% of patients with AMI given PCI within 90 minutes of arrival 48 93
Median time to transfer to another facility for acute coronary intervention 65
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 54.6
% of hospitals with or planning to develop a diversity strategy or plan 54.4

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