New Jersey

Category Grades
17C+ 30D+
Access to Emergency Care:
16C 36F
Quality/Patient Safety:
11A- 19C+
Medical Liability:
50F 44F
Public Health/ Injury Prevention:
13B 11B
Disaster Preparedness:
26C+ 13C+

New Jersey fell 13 places, to 30th, due to worsening scores in Access to Emergency Care and the Quality and Patient Safety Environment. At the same time, the state has failed to significantly improve its poor Medical Liability Environment.

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New Jersey's strongest performance was in Public Health and Injury Prevention, in part because of strong state policies that require child safety seat and adult seatbelt use, prohibit texting and cell phone use while driving, prohibit smoking at worksites and in bars and restaurants, and require helmets for all motorcycle riders. These policies have likely played a critical role in the low traffic fatality rate (4.6 per 100,000 people), high rate of seat belt use (94.5%), and low proportion of adult smokers (16.8%) in the state.

While New Jersey's Disaster Preparedness grade has remained the same since 2009, the state's ranking has moved up 13 places due to improvements in a number of areas. The state has incorporated special needs patients, patients dependent on dialysis, and mental health patients into its medical response plans, and bed surge capacity has significantly improved since 2009 (from 201.2 to 655.6 per 1 million people). New Jersey is one of only 11 states that have a state budget line item for Disaster Preparedness funding specific to health care surge.


New Jersey's Access to Emergency Care has hit a tipping point. The state ranks among the lowest for many measures related to hospital capacity, financial barriers, and availability of providers. It has below-average rates of emergency physicians (11.8 per 100,000 people), ranking 33rd in the nation. The state has below-average rates of neurosurgeons; ear, nose, and throat specialists; and registered nurses. Additionally, New Jersey has one of the highest hospital occupancy rates (74.5%) and a below-average number of staffed inpatient beds (287.2 per 100,000). These factors have likely contributed to the long wait times in the emergency department (ED): The median time from ED arrival to ED departure for admitted patients is 355 minutes, or 5.9 hours, putting New Jersey at 47th nationally.

Despite the persistent need to recruit and retain health care providers, New Jersey's Medical Liability Environment has changed little since 2009. The state has some of the highest average medical liability insurance premiums for physicians and specialists and falls well below average in the number of insurers writing policies (3.7 compared with 11.0 insurers per 1,000 physicians nationally). In addition, the number of malpractice award payments has increased more than threefold since the previous Report Card (3.5 versus 1.0 per 100,000 people). New Jersey lacks pretrial screening panels, periodic payments, and medical liability caps on non-economic damages, all of which would contribute to lessening the burden on physicians and increasing access to care.

While New Jersey continues to support the same practices and policies that resulted in a positive showing in 2009, the addition of new indicators in Quality and Patient Safety has revealed that the state is about average for many quality measures, such as the percentage of hospitals with computerized practitioner order entry (81.3%) and with electronic medical records (91%). More than half of New Jersey's hospitals collect data on patient race or ethnicity and primary language (65.3%).


New Jersey must work harder to attract providers of all types to meet the growing health care needs of its population and improve overall Access to Emergency Care. The state needs to act immediately to alleviate those issues that contribute to crowding and boarding in the ED, including high hospital occupancy rates, hospital closures, and lack of specialists. Compounding these problems, New Jersey has failed to increase Medicaid fees to an adequate level, as currently it pays only 40% of the national average, representing a slight increase since 2007. Grossly inadequate Medicaid fees will continue to make it difficult to recruit and retain vital specialists in the state.

To aid in addressing issues of access to quality emergency care, New Jersey needs to implement medical liability reforms aimed at lowering insurance premiums and reducing excessive malpractice award payments. The state should enact special liability protection for providers of emergency care mandated by the Emergency Medical Treatment and Labor Act who assume significant risks in providing immediate, lifesaving care to patients, often with no knowledge of their medical history. New Jersey should also consider apology inadmissibility laws, pretrial screening panels, and required periodic payments of awards.

While New Jersey fared well in Public Health and Injury Prevention overall, racial and ethnic health disparities persist in infant mortality rates, cardiovascular disease, and HIV diagnoses. For instance, the state has the fourth highest infant mortality disparity ratio, despite having the eighth lowest infant mortality rate, with non-Hispanic black infants 4.5 times more likely to die in their first year than Asians and Pacific Islanders (who had the lowest rate). The state should consider taking action to improve health equity and reduce disparities for these and all racial and ethnic groups.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop
Emergency physicians per 100,000 pop
Neurosurgeons per 100,000 pop
Orthopedists and hand surgeon specialists per 100,000 pop
Plastic surgeons per 100,000 pop
ENT specialists per 100,000 pop
Registered nurses per 100,000 pop
Percent of children able to see provider
Level I or II trauma centers per 1M pop
Percent of population within 60 minutes of Level I or II trauma center
Accredited chest pain centers per 1M pop
Percent of population with an unmet need for substance abuse treatment
Pediatric specialty centers per 1M pop
Medicaid fee levels for office visits as a percent of the national average
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012)
Percent of adults with no health insurance
Percent of adults underinsured
Percent of children with no health insurance
Percent of children underinsured
Percent of adults with Medicaid
Hospital closures in 2006/2011
Staffed inpatient beds per 100,000 pop
Hospital occupancy rate per 100 staffed beds
Psychiatric care beds per 100,000 pop
Median time from ED arrival to ED departure for admitted ED patients
State collects data on diversion

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds
State budget line item health care surge
ESF-8 plan is shared with all EMS and essential hospital personnel
Emergency physician input into the state planning process
Public health and emergency physician input during an ESF-8 response
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP)
Special needs patients included in medical response plan
Patients dependent on medication for chronic conditions in medical response plan
Medical response plan for supplying dialysis
Mental health patients included in medical response plan
Medical response plan for supplying psychotropic medications
Mutual aid agreements in place with behavioral health providers
State requires long-term care and nursing home facilities to have a written disaster plan
State able to report number of exercises involving long-term care facilities or nursing
Just-in-time training systems in place
Statewide medical communication system with one layer of redundancy
Statewide patient tracking system
Statewide real-time or near real-time syndromic surveillance system
Real-time surveillance system in place for common ED presentations
Bed surge capacity per 1M pop
ICU beds per 1M pop
Burn unit beds per 1M pop
Verified burn centers per 1M pop
Physicians registered in ESAR-VHP per 1M pop
Nurses registered in ESAR-VHP per 1M pop
Behavioral health professionals registered in ESAR-VHP per 1M pop
Strike teams or medical assistance teams
Disaster training required for essential hospital/EMS personnel
Percent of RNs that received emergency training

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop
Lawyers per physician
Lawyers per emergency physician
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6)
Malpractice award payments per 100,000 pop
Average malpractice award payments
National Practitioner Databank reports per 1,000 physicians
Apology laws: Apology is inadmissible as evidence in a court of law
State has implemented a patient compensation fund
Number of insurers writing medical liability policies per 1,000 physicians
Average medical liability insurance premiums for primary care physicians
Average medical liability insurance premiums for specialists
Presence of pretrial screening panels
Pretrial screening panel's findings admissible as evidence
Periodic payments are: required, granted upon request, at court's discretion
Medical liability cap on non-economic damages
Additional liability protection for EMTALA-mandated emergency care
Joint and several liability abolished
Collateral Source Rule/Provides for Awards to be Offset
State provides for case certification
Expert witness required to be of the same specialty as the defendant
Expert witness must be licensed to practice medicine in the state

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists
Pedestrian fatalities per 100,000 pedestrians
Percent of traffic fatalities alcohol-related
Percent of front occupants using restraints
Child safety seat/seat belt legislation - score out of a possible 10 points
Helmet use required for all motorcylce riders
Distracted driving legislation score - out of a possible 4 points
Graduated drivers' licenses legislation score -out of a possible 5 points
Percentage of children aged 19-35 months who are immunized
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine
Fatal occupational injuries per 1M workers
Homicides and suicides (non-motor vehicle)(per 100,000)
Unintentional fall-related fatal injuries (per 100,000)
Fire/burn related fatal injuries (per 100,000)
Rate of unintentional firearm-related fatal injuries (per 100,000)
Rate of unintentional poisoning-related deaths (per 100,000)
Total injury prevention funds per 1,000 persons
Dedicated child injury prevention funding
Dedicate elderly injury prevention funding
Dedicated occupational injury prevention funding
Anti-smoking legislation score - score out of a possible 3 points
Infant mortality rate per 1,000 live births
Percentage of adults who binge drink
Percentage of adults who currently smoke
Percentage of adult population who are obese (BMI > 30.0)
Percentage of children who are obese
Cardiovascular disease disparity ratio
HIV diagnosis disparity ratio
Infant mortality disparity ratio

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system
Funded state EMS medical director
Emergency medicine residents per 1M pop
Adverse event reporting required
% of counties with Enhanced 911 capability
State has a uniform system for providing pre-arrival instructions
State uses CDC guidelines for state field triage protocols
State has or is working on a stroke system of care
State has triage and destination policy in place for stroke patients
State has or is working on a PCI network or a STEMI system of care
State has triage and destination policy in place for STEMI patients
State maintains statewide trauma registry
State has triage and destination policy in place for trauma patients
Prescription drug monitoring program score (range 0-4)
% of hospitals with computerized practitioner order entry
% of hospitals with electronic medical records
% of patients with AMI given PCI within 90 minutes of arrival
Median time to transfer to another facility for acute coronary intervention
% of patients with AMI who received aspirin within 24 hours
% of hospitals collecting data on race/ethnicity and primary language
% of hospitals with or planning to develop a diversity strategy or plan

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