Nebraska continues to support a strong overall emergency care environment, ranking fourth in the country, after improving its already strong Medical Liability Environment and showing substantial progress in Disaster Preparedness. Nebraska continues to struggle, however, with low numbers of specialists and limited access to trauma centers.
Nebraska has the lowest medical liability insurance premiums in the country for both primary care providers ($3,837) and specialists ($16,519). Since 2009, the state has also experienced reduced average malpractice award payments ($174,222), fewer malpractice award payments (1.7 per 100,000 population), and a slight increase in the number of insurers writing malpractice policies.
Nebraska improved greatly in Disaster Preparedness, benefiting from high rates of intensive care unit beds, burn unit beds, and burn centers as well as overall bed surge capacity. In addition, Nebraska ranks among the top 10 states for registering physicians and behavioral health providers in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP; 94.3 and 47.4 per 1 million people, respectively). The state also has mutual aid agreements with behavioral health providers to provide care during an event, and it has become accredited by the Emergency Management Accreditation Program (EMAP) since the last Report Card.
Nebraska faces challenges in Access to Emergency Care, having among the lowest number of emergency physicians (8.4 per 100,000 people) and plastic surgeons (1.7 per 100,000) in the nation and below-average rates of orthopedists and hand surgeons (9.2 per 100,000). Additionally, despite high proportions of the population having health insurance, the state has the third highest rate of underinsured children, with unreasonable costs being reported by the parents of 22.2% of children with health insurance. The state also ranked in the bottom 10 for availability of psychiatric care beds (16.0 per 100,000 people) and has a high proportion of adults with an unmet need for substance abuse treatment (9.7%).
Nebraska has failed to improve its Quality and Patient Safety Environment since the previous Report Card. Despite having passed legislation to create a prescription drug monitoring program, a multitude of issues have been noted by emergency physicians that have inhibited the effective implementation of such a program, including individuals' ability to opt out of the program, a subscription fee for physicians to access the program, and failure of some pharmacies to participate. In addition, the state has a low proportion of hospitals that have electronic medical records (83%), collect data on race and ethnicity and primary language (38.8%), and which are planning to implement a diversity strategy (29.6%).
Nebraska's performance in Public Health and Injury Prevention falls at both ends of the spectrum. While the state has some of the lowest rates of bicyclist fatalities, pedestrian fatalities, homicides and suicides, and poisoning-related deaths, it also has some of the highest rates of binge drinking among adults (22.7%) and fatal occupational injuries (45 per 1 million workers). While it has implemented legislation banning smoking in restaurants, bars, and workplaces, one-in-five adults still smoke. Nebraska also has a large proportion of adults who are obese (28.4%), which has increased since the previous Report Card.
Nebraska must work to improve the Quality and Patient Safety Environment by effectively implementing the prescription drug monitoring program that was approved in legislation passed in 2011. The state should work to develop a system for fully monitoring drug schedules II through V and provide real-time access to providers without requiring a subscription fee. Hospitals should be encouraged to adopt electronic medical records and collect and analyze data on patient race and ethnicity and primary language. In addition, the state should fully fund the implementation of a stroke system of care, including developing destination policies that would allow emergency medical services to bypass local hospitals to transport a patient directly to a hospital specialty center.
Nebraska must work to enhance current Public Health and Injury Prevention efforts by maintaining its motorcycle helmet use requirement and considering stronger regulations regarding texting and cell phone use while driving. The state has made good efforts to ban smoking in public places but needs to provide more education and outreach to reduce the proportion of adults who smoke.