New Mexico continues to struggle with many aspects of the emergency care environment, facing high rates of fatal injuries; health care workforce shortages for specialists, primary care, and other providers; and a Medical Liability Environment that serves as a barrier to recruiting and retaining health care professionals.
New Mexico continues to support the Quality and Patient Safety Environment with funding for quality improvement of the emergency medical services (EMS) system and destination policies that allow EMS to bypass local hospitals when necessary to transport ST-elevation myocardial infarction (STEMI), stroke, and trauma patients directly to a hospital specialty center. The state has also increased the number of emergency medicine residents per capita (from 13.7 to 15.3 per 1 million people) since the last Report Card, though this is still well below the national average.
Despite a stagnant grade in Public Health and Injury Prevention, New Mexico managed to move from 32nd to 25th place in this category. The state fared well with regard to health equity, having the lowest disparity ratio in the nation for infant mortality and the eighth lowest HIV diagnosis disparity ratio. New Mexico also has a below-average proportion of adults who binge-drink, and has passed legislation banning smoking in worksites, restaurants, and bars.
While its overall Disaster Preparedness score was poor, New Mexico has moved up five places in this category since 2009. The state has become accredited by the Emergency Management Accreditation Program, has implemented a statewide patient tracking system, and is one of six states that require training for essential hospital personnel in disaster management and response. New Mexico's medical response plans also include special needs patients, patients on dialysis, and mental health patients. The state is one of 18 that address patients dependent on psychotropic medications in their medical response plan.
New Mexico's Access to Emergency Care is ranked second worst in the nation. Financial barriers and major workforce shortages continue to threaten patient health outcomes and the quality of care available. New Mexico has extremely low per capita rates of plastic surgeons; ear, nose, and throat specialists; neurosurgeons; and registered nurses. The state also has primary care and mental health provider shortages, needing an additional 6.7 fulltime primary care providers and 2.0 fulltime mental health providers per 100,000 people to meet the needs of its population. The state ranks 47th for the proportion of adults with an unmet need for substance abuse treatment (10.5%) and next to last for the number of psychiatric care beds available (6.0 per 100,000), which represents a 72% decrease in available psychiatric care beds from 2009.
The Medical Liability Environment in New Mexico fared slightly worse than in the previous Report Card due to an increasing number of malpractice award payments per capita, a slight increase in the average malpractice award, and failure to enact additional liability reforms. The state has seen a dramatic increase in National Practitioner Databank reports, from 28.2 to 41.9 per 1,000 physicians, which may be evidence of an increasingly litigious environment.
New Mexico's Public Health and Injury Prevention infrastructure is burdened by some of the highest rates of fatal injuries in the nation. The state has the second highest rate of homicides and suicides combined (27.6 per 100,000 people) and the third highest rate of poisoning-related deaths, which include overdoses (20.9 per 100,000), and ranks among the 11 worst states for fall-related deaths, pedestrian fatalities, and traffic fatalities.
Poor Access to Emergency Care has negatively affected the quality of care in New Mexico, resulting in long ED wait times, boarding of patients in the ED, and crowding. The state must help address the worsening trends in emergency care system capacity by increasing the number of EDs, staffed inpatient beds, and psychiatric care beds available as well as improving access to substance abuse treatment. Finally, the health care workforce shortage in New Mexico threatens to worsen with full implementation of the Patient Protection and Affordable Care Act, as demand for all types of providers will likely increase across the country.
To help address the workforce shortage and improve access to care, the state should consider medical liability reforms that would offer physicians a fair and supportive environment in which to practice. The state could work to pass apology inadmissibility laws, expert witness rules, and collateral source rule reform, as well as additional liability protections for Emergency Medical Treatment and Labor Actmandated emergency care.
With regard to its Quality and Patient Safety Environment, New Mexico should encourage the implementation of computerized practitioner order entry and electronic medical records among hospitals, both of which currently fall well below the national average. The state should also continue to support an increase in the emergency medicine resident population.