Category Grades
8C+ 6C+
Access to Emergency Care:
23D- 2B+
Quality/Patient Safety:
4A 3A
Medical Liability:
38D- 43F
Public Health/ Injury Prevention:
17B- 21C-
Disaster Preparedness:
4A 17C+

Pennsylvania has made great strides in Access to Emergency Care since the 2009 Report Card, moving from 23rd to 2nd place; however, unmet liability protections for emergency care providers, uncertainty regarding the phase-out of the state's liability insurance program, and declining performance in Disaster Preparedness continue to threaten the emergency care environment.

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Pennsylvania's Access to Emergency Care has improved greatly since the 2009 Report Card. While a variety of sources indicate a mixed picture of the current and future adequacy of the state's supply of health care providers, data in this report indicate below-average rates of health professional shortages, though shortages persist among some specialties. Reports of an aging physician workforce could exacerbate those shortages as the percentage of patients with insurance, which has already increased since the 2009 Report Card, continues to grow under the Affordable Care Act. Also contributing to the improvement in this category was a 79.7% increase in Medicaid fee levels for office visits from 2007 to 2012, although the state's fee levels are still only 80% of the national average. Pennsylvania has a relatively low proportion of adults with an unmet need for substance abuse treatment (7.9%) and below-average rates of underinsurance for both adults (7.4%) and children (15.3%).

Pennsylvania continues to rank among the top in the nation with regard to the Quality and Patient Safety Environment, having statewide systems and policies in place for ST-elevation myocardial infarction, stroke, and trauma patients. It also supports a large number of emergency medicine residents (48.6 per 1 million population), representing the fourth highest rate in the nation.


While some aspects of the state's Medical Liability Environment have improved with the elimination of venue shopping, the adoption of a certificate of merit, and expert witness qualifications, Pennsylvania has not kept up with improvements seen in other states. It still has some of the highest average medical liability insurance premiums for primary care physicians ($20,890) and specialists ($88,865) in the nation. The state also lacks additional protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Finally, the eventual statutorily mandated phase-out of the state's Medical Care Availability and Reduction of Error Act (MCARE) liability insurance program, which could require physicians and hospitals to assume the program's $1.3 billion unfunded liability, continues to cast a dark cloud over providers.

Pennsylvania continues to face challenges with regard to Public Health and Injury Prevention, falling in the bottom third of states with regard to infant mortality rates (7.3 deaths per 1,000 live births) and unintentional poisoning-related deaths (13.4 deaths per 100,000 people). The state has also failed to pass smoking bans in bars and has only limited bans in restaurants, despite having above average rates of smoking among adults (22.4%).

Pennsylvania's grade for Disaster Preparedness was heavily affected by declines in bed surge capacity, intensive care unit beds, burn unit beds, and the proportion of nurses who reported receiving Disaster Preparedness training, compared to the 2009 Report Card. In addition, while Pennsylvania reported significantly higher rates of physicians and nurses registered in the Emergency System for Volunteer Health Professionals than in 2009, the state did not keep pace with the nation, now reporting rates less than half the national averages.


The state must work to adopt a ìclear and convincingî standard for EMTALA-related care, which would require that evidence be provided to show that emergency care personnel's actions were grossly negligent under the given circumstances. Additionally, Pennsylvania needs to phase out the MCARE program in a way that will not negatively affect the state's already high liability premiums.

While Pennsylvania has operationalized a prescription drug monitoring program, the state does not monitor drug schedules II to V and has not implemented a system for real-time access of this information by providers. Doing so would further strengthen the state's Quality and Patient Safety Environment.

Boarding and crowding in the emergency department (ED) and the negative effects that these issues have on patient care and outcomes continue to be major concerns in Pennsylvania, despite its improvement in Access to Emergency Care overall. While state reports indicate that the number of ED visits have increased, Pennsylvania has seen a decrease in the number of EDs, staffed inpatient beds, and psychiatric care beds per population and continues to have a higher-than-average hospital occupancy rate. The commonwealth should adopt a statewide psychiatric bed registry and work closely with hospitals to minimize boarding of admitted patients in EDs.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 10.1 11.9
Emergency physicians per 100,000 pop 14.8 15.5
Neurosurgeons per 100,000 pop 2.2 2.4
Orthopedists and hand surgeon specialists per 100,000 pop 9.9 10.4
Plastic surgeons per 100,000 pop 2.3 2.4
ENT specialists per 100,000 pop 3.7 4
Registered nurses per 100,000 pop 1,018.9 1,025.9
Percent of children able to see provider 96.6
Level I or II trauma centers per 1M pop 1.9 2.1
Percent of population within 60 minutes of Level I or II trauma center 98.8 99.3
Accredited chest pain centers per 1M pop 0.6 2.2
Percent of population with an unmet need for substance abuse treatment 8.1 7.9
Pediatric specialty centers per 1M pop 3.5 3.3
Medicaid fee levels for office visits as a percent of the national average 54.5 79.7
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 38 79.7
Percent of adults with no health insurance 10.8 11.7
Percent of adults underinsured 7.4
Percent of children with no health insurance 7.3 7.6
Percent of children underinsured 15.3
Percent of adults with Medicaid 7.7 9.8
Hospital closures in 2006/2011 2 1
Staffed inpatient beds per 100,000 pop 383.5 356.6
Hospital occupancy rate per 100 staffed beds 72 68.4
Psychiatric care beds per 100,000 pop 35.1 30.4
Median time from ED arrival to ED departure for admitted ED patients 275
State collects data on diversion NO N/A

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.01 $5.18
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) YES, ACCREDITED YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
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 YES
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 YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 639.9 591.1
ICU beds per 1M pop 328.7 323.4
Burn unit beds per 1M pop 5.8 5.6
Verified burn centers per 1M pop 0.321729825 0.4
Physicians registered in ESAR-VHP per 1M pop 3 19.5
Nurses registered in ESAR-VHP per 1M pop 11.2 147.7
Behavioral health professionals registered in ESAR-VHP per 1M pop 5.7
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO, YES
Percent of RNs that received emergency training 38.1 32.9

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 18.4 17.8
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 12.4 11.5
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -2 -1
Malpractice award payments per 100,000 pop 0.9 4.5
Average malpractice award payments $415,168 $327,007
National Practitioner Databank reports per 1,000 physicians 26.7 32.2
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund YES YES
Number of insurers writing medical liability policies per 1,000 physicians 2.7 3
Average medical liability insurance premiums for primary care physicians $23,711 $20,890
Average medical liability insurance premiums for specialists $107,733 $88,865
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 UPON REQUEST OR AGREEMENT OF PARTY(IES) 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 NO 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 YES 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 2.7
Pedestrian fatalities per 100,000 pedestrians 2.8
Percent of traffic fatalities alcohol-related 39 36
Percent of front occupants using restraints 86.7 83.8
Child safety seat/seat belt legislation - score out of a possible 10 points 4 5
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 2
Percentage of children aged 19-35 months who are immunized 84.4 75.4
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 68.3 62.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 68.8 73
Fatal occupational injuries per 1M workers 39.2 32
Homicides and suicides (non-motor vehicle)(per 100,000) 17.6 17.9
Unintentional fall-related fatal injuries (per 100,000) 7.7 11.2
Fire/burn related fatal injuries (per 100,000) 1.3 1.2
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 13.4
Total injury prevention funds per 1,000 persons $445.11 $263.40
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding YES
Anti-smoking legislation score - score out of a possible 3 points 1
Infant mortality rate per 1,000 live births 7.3 7.3
Percentage of adults who binge drink 16.6 18.3
Percentage of adults who currently smoke 21.5 22.4
Percentage of adult population who are obese (BMI > 30.0) 24 28.6
Percentage of children who are obese 13.5
Cardiovascular disease disparity ratio 2
HIV diagnosis disparity ratio 13.3
Infant mortality disparity ratio 2.4

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 29.1 48.6
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 97 100
State has a uniform system for providing pre-arrival instructions YES 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 YES
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) 2
% of hospitals with computerized practitioner order entry 28.4 76.8
% of hospitals with electronic medical records 47.3 93.2
% of patients with AMI given PCI within 90 minutes of arrival 49 93
Median time to transfer to another facility for acute coronary intervention 68
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 60.1
% of hospitals with or planning to develop a diversity strategy or plan 44.4

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