Minnesota’s noteworthy successes include substantial funding of injury prevention programs and a comprehensive approach to effective disaster planning, but the Medicaid reimbursement rate for office visits and the state’s Medical Liability Environment present ample opportunities for improvement.
Strengths. Minnesota has undertaken multiple efforts to increase its capacity in the event of a disaster. The state has an all-hazards medical response plan and receives public health and emergency physician input into the state planning process. Minnesota has established a statewide medical communication system with one layer of redundancy, a real-time notification system, and statewide patient and victim tracking systems. The state ranks fourth with regard to the number of nurses who are registered with the state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program. Minnesota also ranks 6th overall for the number of preparedness drills and exercises conducted with hospital personnel and equipment and 13th for the number of physicians registered with ESAR-VHP.
Minnesota also fared well with regard to Public Health and Injury Prevention. The state invests heavily in injury prevention programs: Total injury prevention funding is nearly $600 per 1,000 people compared to an average of $455 per 1,000 across the states. The state also has high immunization rates for both children and adults and relatively low rates of traffic fatalities and unintentional fatalities from fires and firearms. Minnesota has one of the lowest infant mortality rates in the nation (5.1 per 1,000 live births compared to 6.9 per 1,000 nationally). Obesity and cigarette smoking among adults (24.7 and 18.3 percent, respectively) are slightly lower than the nation as a whole (25.1 and 20.1 percent, respectively).
Minnesota’s Quality and Patient Safety Environment benefits from mandatory quality reporting requirements, a statewide trauma registry, and the development of a stroke system of care. The state has a funded EMS medical director, ranks 14th for the number of emergency medicine residents per capita, and has Enhanced 911 capability in every county. Most notably, Minnesota is ranked first in the nation for the proportion of eligible patients with acute myocardial infarction receiving PCI within 90 minutes of hospital arrival (83 percent).
Challenges. Minnesota’s Medical Liability Environment is ranked 26th overall due to a paucity of liability reforms. The state has abolished joint and several liability but lacks pretrial screening panels, medical liability caps on non-economic damages, and additional liability protections for EMTALA-mandated emergency care. The state also has a relatively high average malpractice award ($347,708) compared to the average across the states ($285,218).
Regarding Access to Emergency Care, Minnesota is ranked 29th for the number of emergency physicians per capita, has no accredited chest pain centers, and is ranked 40th for access to substance abuse treatment. The state also has disproportionately low Medicaid fee levels for office visits (68.4 percent of the national average), which is the result of a 13.0 percent decline since 2004.
Recommendations. While the state has taken some steps, including collecting data on ambulance diversions, Minnesota must address numerous issues that severely impact Access to Emergency Care. Emergency physicians in Minnesota have identified crowding and boarding in the state’s more urban areas, as well as the resulting ambulance diversion, as a serious concerns. These complex issues are likely exacerbated by the relatively high daily hospital occupancy rate in the state and the lack of on-call specialists available to provide timely emergency care. Additionally, emergency physicians report that the state’s shortage of psychiatric care beds is resulting in psychiatric patients being increasingly boarded in emergency departments while they await placement in an appropriate facility to receive the psychiatric treatment they need.
Minnesota could further improve the Quality and Patient Safety Environment with funding for EMS quality improvement, implementing a uniform system for providing pre-arrival instructions, and requiring reporting of hospital-based infections.
The lack of liability reform is also a continuing issue, and policymakers should work with the medical community to enact legislation, such as special liability protections for providers of EMTALA-mandated care, which might encourage more specialists to provide on-call emergency services.