Category Grades
43D+ 46D
Access to Emergency Care:
37D- 32F
Quality/Patient Safety:
47D- 33C-
Medical Liability:
41D- 33D
Public Health/ Injury Prevention:
21C 27D+
Disaster Preparedness:
12B+ 25C-

Michigan has made extensive improvements in its Quality and Patient Safety Environment, implementing key policies and practices to improve the timeliness of emergency care. However, the state's weak Medical Liability Environment and issues with adequate hospital capacity continue to hamper progress in improving the overall emergency care environment.

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Michigan has worked to improve its Quality and Patient Safety Environment over the past 5 years. The state has implemented a statewide trauma registry. The vast majority of the state's hospitals have adopted computerized practitioner order entry (91.1%) and electronic medical records (97.5%). Michigan has also begun the process of implementing overall trauma system and destination protocols and is developing administrative rules that will address verification and designation of STEMI and stroke centers, along with triage criteria and destination protocols.

While Michigan has fallen further behind other states in Disaster Preparedness, it maintains a number of policies and procedures to ensure that it can mount a coordinated and effective disaster response. The state has conducted many drills and exercises involving hospitals (4.5 per hospital in 2011) and tracks exercises involving long-term care and nursing home facilities. Special needs patients, patients dependent on dialysis, and mental health patients are included in Michigan's medical response plan, and there is a statewide patient tracking system in place. The state is accredited by the Emergency Management Accreditation Program and has moderate levels of health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals. In terms of hospital capacity, Michigan has better than average access to burn centers and burn unit beds, although its bed surge capacity is relatively low, compared with the rest of the nation.


Michigan's main challenge is ensuring Access to Emergency Care. Although the state has high per capita rates of emergency physicians, it has below average rates of specialists, such as orthopedists and hand surgeons; plastic surgeons; and ear, nose, and throat specialists. There is also concern that Michigan lacks an adequate supply of psychiatric care beds (21.5 per 100,000 people) and staffed inpatient beds (286.9 per 100,000 people). In addition, financial barriers to care may impede access to preventive and emergency care, with a high proportion of adults reporting that they delayed or declined care due to cost (9.3%). Michigan's Medicaid fee levels for office visits are also among the lowest in the nation, at 60.5% of the national average.

In Public Health and Injury Prevention, Michigan falls below average on many indicators, and some worrying numbers stand out: Michigan ranks among the worst in the nation for adult obesity (31.3%) and a relatively high proportion of adults currently smoke (23.3%). The state has one of the lowest rates of pneumonia vaccination among older adults (67.1%). The proportion of older adults receiving an annual influenza vaccination has decreased significantly since the last Report Card, from 71.3% to 58.0%, which may also indicate financial barriers to care.


Michigan should continue to strengthen its Medical Liability Environment, particularly by passing additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), such as those requiring clear and convincing evidence of gross negligence, as has been proposed in legislation in recent years. This will help ensure Access to Emergency Care, especially the availability of on-call specialists, which is a major concern in the state. Other potential reforms include abolishing joint and several liability and establishing pretrial screening panels to discourage unfounded lawsuits.

Michigan must work to improve Access to Emergency Care by reducing financial barriers to care and increasing its capacity to care for high-risk patients. The state would also benefit from a concerted immunization outreach and education effort, especially for its older population.

In April 2012, a new law went into effect in Michigan allowing motorcycle riders 21 years of age and older to ride without a helmet. Subsequently, a report from the Governors' Highway Safety Association showed a substantial increase in motorcycle fatalities during the first 9 months of 2012. In addition to the significantly heightened risk of fatal and serious injury associated with repeal of the state's all-rider helmet law, the new law requires helmetless riders to maintain only $20,000 in medical insurance, leaving injured motorcyclists and their families vulnerable to uncovered medical bills. While reinstatement of the all-rider helmet law should be a priority, the state should take steps to ensure that helmetless motorcyclists have adequate insurance to cover treatment of significant injuries and to ensure access to care. Similar attention should be paid to maintaining the state's no-fault automobile insurance provisions that do not limit medical coverage for those severely injured in automobile crashes.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 11 13.8
Emergency physicians per 100,000 pop 15.3 17.8
Neurosurgeons per 100,000 pop 1.6 1.9
Orthopedists and hand surgeon specialists per 100,000 pop 8.2 9.0
Plastic surgeons per 100,000 pop 2 2.1
ENT specialists per 100,000 pop 2.8 3.2
Registered nurses per 100,000 pop 836.2 907.9
Percent of children able to see provider 95.3
Level I or II trauma centers per 1M pop 1.6 2.2
Percent of population within 60 minutes of Level I or II trauma center 85.1 91.7
Accredited chest pain centers per 1M pop 0.9 .17
Percent of population with an unmet need for substance abuse treatment 8.4 9.1
Pediatric specialty centers per 1M pop 2.8 2.1
Medicaid fee levels for office visits as a percent of the national average 79.9 60.5
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) NR -7
Percent of adults with no health insurance 12.3 14.7
Percent of adults underinsured 9.3
Percent of children with no health insurance 4.7 5.4
Percent of children underinsured 16.9
Percent of adults with Medicaid 8.2 11.9
Hospital closures in 2006/2011 2 1
Staffed inpatient beds per 100,000 pop 289.3 286.9
Hospital occupancy rate per 100 staffed beds 67 66.8
Psychiatric care beds per 100,000 pop 23.5 21.5
Median time from ED arrival to ED departure for admitted ED patients 291
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $8.10 $4.75
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel NO 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 NO
Medical response plan for supplying dialysis NO YES
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 ACROSS COALITIONS
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 YES YES, STATEWIDE
Bed surge capacity per 1M pop 871.2 578.1
ICU beds per 1M pop 288.1 279.8
Burn unit beds per 1M pop 7.8 8.0
Verified burn centers per 1M pop 0.198573802 0.3
Physicians registered in ESAR-VHP per 1M pop 11.8 20
Nurses registered in ESAR-VHP per 1M pop 77.1 201.8
Behavioral health professionals registered in ESAR-VHP per 1M pop 35.2
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, YES NO
Percent of RNs that received emergency training 38.5 33.1

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.4 13.9
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 9.4 7.8
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -1 0
Malpractice award payments per 100,000 pop 0.7 2.6
Average malpractice award payments $122,876 $184,095
National Practitioner Databank reports per 1,000 physicians 20 21.8
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 2.4 3.2
Average medical liability insurance premiums for primary care physicians $29,713 $20,233
Average medical liability insurance premiums for specialists $98,951 $65,941
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 NO NO
Medical liability cap on non-economic damages >$500,000 >$500,000
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification YES YES
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
Report Card
Bicyclist fatalities per 100,000 cyclists 4.8
Pedestrian fatalities per 100,000 pedestrians 5.2
Percent of traffic fatalities alcohol-related 41 33
Percent of front occupants using restraints 93.7 94.5
Child safety seat/seat belt legislation - score out of a possible 10 points 7 7
Helmet use required for all motorcylce riders YES 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 80 76.4
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 71.3 58
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 67.6 67.1
Fatal occupational injuries per 1M workers 28.5 30.5
Homicides and suicides (non-motor vehicle)(per 100,000) 17.7 18.6
Unintentional fall-related fatal injuries (per 100,000) 6.3 8.5
Fire/burn related fatal injuries (per 100,000) 1.3 1.2
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 10.7
Total injury prevention funds per 1,000 persons $205.24 $248.11
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 7.9 7.1
Percentage of adults who binge drink 17.7 19.7
Percentage of adults who currently smoke 22.4 23.3
Percentage of adult population who are obese (BMI > 30.0) 28.8 31.5
Percentage of children who are obese 14.8
Cardiovascular disease disparity ratio 1.8
HIV diagnosis disparity ratio 17.2
Infant mortality disparity ratio 2.8

Quality & Patient Safety

Title 2009
Report Card
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 37.6 66.2
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 98.8 100
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
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 NO YES
State has triage and destination policy in place for trauma patients NO
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 24.8 91.1
% of hospitals with electronic medical records 45.6 97.5
% of patients with AMI given PCI within 90 minutes of arrival 61 93
Median time to transfer to another facility for acute coronary intervention 55
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 66.7
% of hospitals with or planning to develop a diversity strategy or plan 58

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