Category Grades
27C 21C-
Access to Emergency Care:
26C- 19C-
Quality/Patient Safety:
34D+ 31C-
Medical Liability:
15C+ 18C+
Public Health/ Injury Prevention:
31D+ 20C+
Disaster Preparedness:
17B 39F

Wisconsin's emergency medical system is robust, with above-average rankings for the Medical Liability Environment and Access to Emergency Care, along with low rates of injury. However, the state's Disaster Preparedness planning and policies related to the Quality and Patient Safety Environment are subpar.

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Wisconsin's Medical Liability Environment has a number of reforms in place that help ensure adequate access to care. Wisconsin boasts the lowest per capita rate of malpractice award payments in the nation (0.7 per 100,000 people), and the amounts of the awards themselves are generally well below average. In addition, the average medical liability insurance premiums for both primary care physicians and specialists are the fourth lowest in the country ($5,880 and $22,017, respectively). Wisconsin has placed caps on medical liability payments for non-economic damages and implemented a patient compensation fund. Periodic payments, which can lessen the burden of excessive award payments, are also required by the state.

Wisconsin has improved in Public Health and Injury Prevention, rising from below average on the 2009 Report Card to 20th in the nation. The state now has the fifth highest rate of childhood immunizations (81.5%), and the sixth highest rate of pneumonia vaccination among older adults (74%). Wisconsin does have some areas of concern, such as the second highest rate of accidental fall-related deaths in the nation (17.1 per 100,000 people), though dedicated funding is available to address injury prevention for older adults and children. The state also has a high rate of binge drinking among adults (24.3%).


Wisconsin has slipped in the Disaster Preparedness rankings, largely by not keeping pace with other states. The state lacks some essential provisions that help ensure a quick disaster response and manage patient flow, including a statewide medical communication system with redundancy and a statewide patient tracking system. Wisconsin's planning processes do not include input from emergency physicians, and its Emergency Support Function 8 plan is not shared with essential hospital and emergency medical services personnel.

Wisconsin has some challenges in Access to Emergency Care, notably in access to behavioral health resources. The state has the second highest need for mental health care providers in the nation, with 3.4 additional full-time providers needed per 100,000 people to eliminate the shortage. More than 10% of the state's population has an unmet need for substance abuse treatment, the sixth highest in the country. These numbers, coupled with Wisconsin's high binge drinking numbers and aboveaverage rates of alcohol-related traffic injuries, indicate that this is a critical gap in the state's overall health care system.

There is some evidence that Wisconsin's denizens are not enjoying equal access to preventive care. Wisconsin has one of the highest cardiovascular disease disparity ratios in the country: The state's American Indian/Alaska Native population is almost three times more likely to suffer from this chronic condition as the race or ethnicity least likely to do so. Wisconsin's HIV disparity is also stark, with Black individuals being about 13 times more likely to receive an HIV diagnosis than White individuals. The state needs to ensure that disadvantaged populations are receiving preventive care and education and have access to adequate treatment services.


Overall, Wisconsin has a relatively strong emergency care system, but there are improvements that could be made. While the state has an average-sized health care workforce, its hospital capacity is lacking. Wisconsin has a below-average rate of staffed inpatient beds (264.6 per 100,000 people), and its low rate of intensive care unit beds (196.5 per 1 million people) is a contributor to its poor Disaster Preparedness score. An increase in hospital capacity could improve access to care in both every day and disaster situations.

Wisconsin has one of the country's lowest Medicaid reimbursement rates, at only 65.9% of the national average. Increasing this rate will help ensure that the state can recruit and retain physicians willing to treat this vulnerable population.

The state could enhance its liability environment and encourage specialists to provide critical on-call services to emergency patients by enacting special liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care.

Wisconsin could improve the policies and procedures in its Quality and Patient Safety Environment, particularly those that help first responders and emergency physicians treat vulnerable patients. The state currently does not have a uniform system for providing pre-arrival instructions, nor does it have triage and destination policies in place for stroke or ST-elevation myocardial infarction (STEMI) patients. Putting such policies in place would help ensure that these patients receive the time-sensitive and evidence-based care needed for a better prognosis.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.3 9.0
Emergency physicians per 100,000 pop 10.2 11.8
Neurosurgeons per 100,000 pop 2.1 2
Orthopedists and hand surgeon specialists per 100,000 pop 9.9 9.7
Plastic surgeons per 100,000 pop 1.8 1.9
ENT specialists per 100,000 pop 3.7 3.7
Registered nurses per 100,000 pop 909.6 988.3
Percent of children able to see provider 95.2
Level I or II trauma centers per 1M pop 1.4 1.7
Percent of population within 60 minutes of Level I or II trauma center 85.8 93.2
Accredited chest pain centers per 1M pop 2.9 3.3
Percent of population with an unmet need for substance abuse treatment 10.2 10.2
Pediatric specialty centers per 1M pop 7.9 7.7
Medicaid fee levels for office visits as a percent of the national average 80.2 65.9
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) -19 1
Percent of adults with no health insurance 10 11.8
Percent of adults underinsured 7.1
Percent of children with no health insurance 4.9 5.8
Percent of children underinsured 19.8
Percent of adults with Medicaid 7.4 10.6
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 301.5 264.6
Hospital occupancy rate per 100 staffed beds 64.6 62.5
Psychiatric care beds per 100,000 pop 29.3 24.4
Median time from ED arrival to ED departure for admitted ED patients 204
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.63 $4.72
State budget line item health care surge YES
ESF-8 plan is shared with all EMS and essential hospital personnel YES NO
Emergency physician input into the state planning process YES, YES NO
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 NO
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
Mutual aid agreements in place with behavioral health providers LOCAL 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 NO
Just-in-time training systems in place STATEWIDE COUNTY OR CITYWIDE
Statewide medical communication system with one layer of redundancy YES NO
Statewide patient tracking system YES NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, IN METROPOLITAN AREAS
Bed surge capacity per 1M pop 1,249.6 1,101.6
ICU beds per 1M pop 287.8 196.5
Burn unit beds per 1M pop 5.5 4.7
Verified burn centers per 1M pop 0.357038296 0.2
Physicians registered in ESAR-VHP per 1M pop 29.3 31.8
Nurses registered in ESAR-VHP per 1M pop 128.7 182
Behavioral health professionals registered in ESAR-VHP per 1M pop 37
Strike teams or medical assistance teams YES NO
Disaster training required for essential hospital/EMS personnel NO, NO NO, YES
Percent of RNs that received emergency training 33.8 36.6

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 12.5 13
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 12.2 11.1
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 1
Malpractice award payments per 100,000 pop 1 0.7
Average malpractice award payments $405,958 $243,703
National Practitioner Databank reports per 1,000 physicians 10.1 7.8
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 3.9 4.7
Average medical liability insurance premiums for primary care physicians $6,649 $5,880
Average medical liability insurance premiums for specialists $26,526 $22,017
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 REQUIRED BY STATE REQUIRED
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 PARTIALLY
Collateral Source Rule/Provides for Awards to be Offset YES, NO OFFSET
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 2.1
Pedestrian fatalities per 100,000 pedestrians 2.5
Percent of traffic fatalities alcohol-related 50 39
Percent of front occupants using restraints 75.3 79
Child safety seat/seat belt legislation - score out of a possible 10 points 5 8
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 0
Percentage of children aged 19-35 months who are immunized 86.9 81.5
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 72 56.5
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 71.9 74
Fatal occupational injuries per 1M workers 38.3 28.7
Homicides and suicides (non-motor vehicle)(per 100,000) 15.9 16.1
Unintentional fall-related fatal injuries (per 100,000) 14.6 17.1
Fire/burn related fatal injuries (per 100,000) 0.9 0.8
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 9.0
Total injury prevention funds per 1,000 persons $249.03 $218.55
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
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 6.6 5.8
Percentage of adults who binge drink 24.3 24.3
Percentage of adults who currently smoke 20.8 20.9
Percentage of adult population who are obese (BMI > 30.0) 26.6 27.7
Percentage of children who are obese 13.4
Cardiovascular disease disparity ratio 2.8
HIV diagnosis disparity ratio 13.6
Infant mortality disparity ratio 2.6

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES NO
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 4.3 8.6
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 97.2 98.6
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
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 NO YES
State has triage and destination policy in place for STEMI patients NO
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 24 83.2
% of hospitals with electronic medical records 48.8 98.5
% of patients with AMI given PCI within 90 minutes of arrival 72 93
Median time to transfer to another facility for acute coronary intervention 54
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 70
% of hospitals with or planning to develop a diversity strategy or plan 60

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