Category Grades
5C+ 4B-
Access to Emergency Care:
4B 9C
Quality/Patient Safety:
23C+ 24C+
Medical Liability:
13C+ 5B+
Public Health/ Injury Prevention:
19B- 16B-
Disaster Preparedness:
35C- 7B-

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.

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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.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 5.5 6.3
Emergency physicians per 100,000 pop 7.3 8.4
Neurosurgeons per 100,000 pop 1.8 2.1
Orthopedists and hand surgeon specialists per 100,000 pop 9.4 9.2
Plastic surgeons per 100,000 pop 1.7 1.7
ENT specialists per 100,000 pop 3.9 3.7
Registered nurses per 100,000 pop 1,013.2 1,040.6
Percent of children able to see provider 96.9
Level I or II trauma centers per 1M pop 1.7 2.7
Percent of population within 60 minutes of Level I or II trauma center 77.1 82.3
Accredited chest pain centers per 1M pop 2.8 10.2
Percent of population with an unmet need for substance abuse treatment 9.2 9.7
Pediatric specialty centers per 1M pop 4.5 7.5
Medicaid fee levels for office visits as a percent of the national average 100.7 93.3
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 10 13.8
Percent of adults with no health insurance 13.1 13.7
Percent of adults underinsured 6.2
Percent of children with no health insurance 10.1 8.2
Percent of children underinsured 22.2
Percent of adults with Medicaid 5.3 6.5
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 500.9 421.4
Hospital occupancy rate per 100 staffed beds 64.5 58.1
Psychiatric care beds per 100,000 pop 39.5 16
Median time from ED arrival to ED departure for admitted ED patients 209
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.80 $7.81
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 NO NR
Patients dependent on medication for chronic conditions in medical response plan NO NR
Medical response plan for supplying dialysis NO NR
Mental health patients included in medical response plan NR
Medical response plan for supplying psychotropic medications NR
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 NR
Just-in-time training systems in place NR STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations NO YES, STATEWIDE
Bed surge capacity per 1M pop 760.7 1,518.2
ICU beds per 1M pop 354.9 378.3
Burn unit beds per 1M pop 15.8 12.4
Verified burn centers per 1M pop 1.127032956 0.5
Physicians registered in ESAR-VHP per 1M pop 9.6 94.3
Nurses registered in ESAR-VHP per 1M pop 0 225.8
Behavioral health professionals registered in ESAR-VHP per 1M pop 47.4
Strike teams or medical assistance teams YES NO
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 36.2 44.1

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.1 13.5
Lawyers per physician 0.6 0.5
Lawyers per emergency physician 19.1 16.1
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 2.9 1.7
Average malpractice award payments $297,248 $174,222
National Practitioner Databank reports per 1,000 physicians 18.8 22.5
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund YES YES
Number of insurers writing medical liability policies per 1,000 physicians 11.9 13.6
Average medical liability insurance premiums for primary care physicians $5,753 $3,837
Average medical liability insurance premiums for specialists $21,811 $16,519
Presence of pretrial screening panels MANDATORY MANDATORY
Pretrial screening panel's findings admissible as evidence YES YES
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 YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
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 1.5
Pedestrian fatalities per 100,000 pedestrians 1.3
Percent of traffic fatalities alcohol-related 33 30
Percent of front occupants using restraints 78.7 84.2
Child safety seat/seat belt legislation - score out of a possible 10 points 2 2
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 1
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 80.8 82.9
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 73.3 61.8
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 68.3 70.3
Fatal occupational injuries per 1M workers 48.7 45
Homicides and suicides (non-motor vehicle)(per 100,000) 13.1 13.6
Unintentional fall-related fatal injuries (per 100,000) 8.6 11.1
Fire/burn related fatal injuries (per 100,000) 1.1 0.9
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 5.6
Total injury prevention funds per 1,000 persons $369.67 $317.06
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 5.6 5.3
Percentage of adults who binge drink 18.1 22.7
Percentage of adults who currently smoke 18.7 20
Percentage of adult population who are obese (BMI > 30.0) 26.9 28.4
Percentage of children who are obese 13.8
Cardiovascular disease disparity ratio 2.6
HIV diagnosis disparity ratio 11
Infant mortality disparity ratio 2.6

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director NO YES
Emergency medicine residents per 1M pop 10.1 12.4
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 92.6 100
State has a uniform system for providing pre-arrival instructions NO YES
State uses CDC guidelines for state field triage protocols YES (2006)
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 YES
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) 1
% of hospitals with computerized practitioner order entry 9.4 78.4
% of hospitals with electronic medical records 18.8 83
% of patients with AMI given PCI within 90 minutes of arrival 76 91
Median time to transfer to another facility for acute coronary intervention 58
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 38.8
% of hospitals with or planning to develop a diversity strategy or plan 29.6

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