Category Grades
6C+ 12C
Access to Emergency Care:
20C 15C-
Quality/Patient Safety:
19B- 40D
Medical Liability:
26C- 13B-
Public Health/ Injury Prevention:
10B 6A-
Disaster Preparedness:
7A- 28C-

Minnesota's commitment to Public Health and Injury Prevention is reflected in low fatal injury rates and a fairly healthy population. Additionally, its citizens enjoy comparatively good access to physicians and medical facilities. However, Minnesota has fallen behind in putting uniform policies and practices in place for promoting quick and effective response to emergencies both during disasters and in everyday situations.

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Minnesota continues to rank among the top performing states in Public Health and Injury Prevention, with a demonstrated commitment to injury prevention funding for children and the elderly and a high level of overall funding ($485.48 per 1,000 people). It has very low rates of homicides and suicides; fire- and burn-related deaths; and poisoning-related deaths, which include drug overdoses. Minnesota's only poor rating is its rate of fall-related deaths (14.8 per 100,000 people), which is significantly higher than the national average (9.5 per 100,000 people). The state has relatively high rates of immunizations among both older adults and children and one of the lowest infant mortality rates in the nation (4.5 deaths per 1,000 births).

Minnesota has improved its Access to Emergency Care ranking since the previous Report Card and boasts the highest per capita rate of physicians accepting Medicare in the nation (5.5 for every 100 beneficiaries). The state has relatively high Medicaid fee levels for office visits (112.1% of the national average). Minnesota fares well with low proportions of adults with no health insurance (10.1%) and inadequate insurance (6.5%) and a fairly low proportion of children with no health insurance (6.4%). There are some insurance gaps, however, as the state's children have the highest rate of underinsurance in the nation (23.2%). Minnesota has fair per capita rates of specialists and certain facilities, such as emergency departments and level I and II trauma centers, but has exceedingly low rates of accredited chest pain centers.


Minnesota's ranking in the Quality and Patient Safety Environment fell substantially, in part due to a lack of state-wide policies and procedures for enhancing emergency medical services (EMS) systems. The state did not report funding for a state EMS medical director position. Minnesota also lacks a uniform system for providing pre-arrival instructions that could offer an opportunity to provide life-saving care, and it does not have state field triage protocols in place. It has, however, increased the number of emergency medicine residents to be close to the national average and has been working on a percutaneous coronary intervention (PCI) network or ST-elevation myocardial infarction (STEMI) system of care.

The strength of Minnesota's Disaster Preparedness planning has also slipped compared with other states. Minnesota has particularly strong systems in place to ensure an adequately trained medical response, with just-in-time training systems in place statewide and a high percentage of nurses who have received disaster training (48.2%). However, Minnesota's medical response plan does not specifically address patients dependent on medication for chronic conditions, patients dependent on dialysis, patients on psychotropic medication, and mental health patients. Despite a high bed surge capacity (1428.1 per 1 million people) and availability of burn unit beds (11.2 per 1 million people), Minnesota has a very low number of ICU beds available in the event of a disaster (226.4 per 1 million people).


Minnesota should work to further enhance its safeguards for Quality and Patient Safety in its emergency care system by exploring destination policies to ensure that stroke and STEMI patients are triaged to the most appropriate medical facilities. Adopting other state-level standards, such as field triage protocols and uniform systems for providing pre-arrival instructions, would also improve the overall environment.

Minnesota's Medical Liability Environment could be stronger. While the state has the second lowest medical liability insurance premiums for primary care physicians ($4,202) and specialists ($16,674), it lacks some needed liability protections for health care providers. The state does not have a cap on non-economic damages, which may help reduce what are some of the highest average malpractice award payments in the nation ($584,175). Minnesota should also protect its emergency care providers with additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act.

Minnesota should explore its high rates of binge drinking and lack of access to substance abuse treatment and ensure that there are systems and processes in place for education, outreach, and treatment. The state should also take note of the few psychiatric care beds available (17.7 per 100,000 people) and work to fill the gap in mental health providers (0.5 full-time providers needed per 100,000 people), which may alleviate emergency department boarding of mental health patients.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 7.6 9.1
Emergency physicians per 100,000 pop 11.1 13.3
Neurosurgeons per 100,000 pop 1.8 2
Orthopedists and hand surgeon specialists per 100,000 pop 10.7 11.6
Plastic surgeons per 100,000 pop 1.9 1.9
ENT specialists per 100,000 pop 3.4 3.5
Registered nurses per 100,000 pop 1,022.2 1,059.6
Percent of children able to see provider 97
Level I or II trauma centers per 1M pop 1.4 1.7
Percent of population within 60 minutes of Level I or II trauma center 82.4 89.9
Accredited chest pain centers per 1M pop 0 0.6
Percent of population with an unmet need for substance abuse treatment 9 10.1
Pediatric specialty centers per 1M pop 3.3 2.2
Medicaid fee levels for office visits as a percent of the national average 68.4 112.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) -13 101.3
Percent of adults with no health insurance 9.5 10.1
Percent of adults underinsured 6.5
Percent of children with no health insurance 8.3 6.4
Percent of children underinsured 23.2
Percent of adults with Medicaid 9.1 10.7
Hospital closures in 2006/2011 1 0
Staffed inpatient beds per 100,000 pop 351.1 301.5
Hospital occupancy rate per 100 staffed beds 69.9 66.2
Psychiatric care beds per 100,000 pop 14.8 17.7
Median time from ED arrival to ED departure for admitted ED patients 202
State collects data on diversion YES NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.08 $5.56
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 NO
Special needs patients included in medical response plan NR YES
Patients dependent on medication for chronic conditions in medical response plan NR NO
Medical response plan for supplying dialysis NR NO
Mental health patients included in medical response plan NO
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 NO
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 NO NO
Real-time surveillance system in place for common ED presentations YES NO
Bed surge capacity per 1M pop 714.6 1,428.1
ICU beds per 1M pop 242.7 226.4
Burn unit beds per 1M pop 9.4 11.2
Verified burn centers per 1M pop 0.384791427 0.4
Physicians registered in ESAR-VHP per 1M pop 33.3 22.1
Nurses registered in ESAR-VHP per 1M pop 390.2 315.5
Behavioral health professionals registered in ESAR-VHP per 1M pop 9.1
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO
Percent of RNs that received emergency training 46.0 48.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 20.1 18.1
Lawyers per physician 0.7 0.6
Lawyers per emergency physician 17.9 13.7
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1 0.9
Average malpractice award payments $347,708 $584,175
National Practitioner Databank reports per 1,000 physicians 7.9 8.2
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 3.5 4.4
Average medical liability insurance premiums for primary care physicians $5,611 $4,202
Average medical liability insurance premiums for specialists $22,941 $16,674
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 YES YES
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 2.2
Pedestrian fatalities per 100,000 pedestrians 2.1
Percent of traffic fatalities alcohol-related 37 36
Percent of front occupants using restraints 87.8 92.7
Child safety seat/seat belt legislation - score out of a possible 10 points 0 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 84.7 79
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 73.8 63.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 71.1 74.2
Fatal occupational injuries per 1M workers 29.4 21.7
Homicides and suicides (non-motor vehicle)(per 100,000) 13.4 13.4
Unintentional fall-related fatal injuries (per 100,000) 11.4 14.8
Fire/burn related fatal injuries (per 100,000) 0.7 0.6
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.1 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 6.7
Total injury prevention funds per 1,000 persons $598.81 $485.48
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
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 5.1 4.5
Percentage of adults who binge drink 17.6 22.1
Percentage of adults who currently smoke 18.3 19.1
Percentage of adult population who are obese (BMI > 30.0) 24.7 25.7
Percentage of children who are obese 14
Cardiovascular disease disparity ratio 2.6
HIV diagnosis disparity ratio 14.9
Infant mortality disparity ratio 2.4

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO NR
Funded state EMS medical director YES NO
Emergency medicine residents per 1M pop 15.2 16.2
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100 100
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 NO
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 23.8 86.8
% of hospitals with electronic medical records 48.3 97.8
% of patients with AMI given PCI within 90 minutes of arrival 83 94
Median time to transfer to another facility for acute coronary intervention 54
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 58.8
% of hospitals with or planning to develop a diversity strategy or plan 41.9

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