New Jersey scored well for its efforts to improve quality and prevent injuries, but the state still faces significant challenges including a low number of emergency departments, high hospital occupancy rates, and substantial concerns in the medical liability arena.
Strengths. New Jersey’s Public Health and Injury Prevention grade benefitted from high scores for traffic safety and fatal injury rates. The state has a universal motorcycle helmet law, as well as a high rate of seat belt use (91.4 percent among front occupants). The state also has among the lowest per capita rates of fatal occupational injuries, fatal unintentional injuries, homicides and suicides, and traffic fatalities. New Jersey also has below average rates of obesity and smoking among adults.
New Jersey has numerous systems and standards in place to promote the Quality and Patient Safety Environment. There is a uniform system for providing pre-arrival instructions, a statewide trauma registry, and relatively widespread use of electronic medical records and computerized practitioner order entry in hospitals. In addition, every county in the state has Enhanced 911 capability.
Regarding Access to Emergency Care, New Jersey ranks highly for indicators such as population proximity to a Level I or II trauma center (tied for first), availability of primary care physicians (third), and access to substance abuse treatment (second). The state also has higher-than-average rates of orthopedists and hand surgeons.
New Jersey receives an average score for Disaster Preparedness. The state has put in place an all-hazards medical response plan and receives input from public health and emergency physicians. The state also has a statewide medical communication system with one layer of redundancy; a statewide patient tracking system; and an established, real-time notification system to notify health professionals of an event.
Challenges. The Medical Liability Environment in New Jersey is in crisis. The state’s average medical liability insurance premiums for primary care physicians and specialists ($20,993 and $93,628, respectively) are more than 30 percent higher than the averages across the states. The state’s average malpractice award payment ($369,077) is also significantly higher than the average across the states ($285,218). Despite recent increases in the number of commercial medical liability insurers, the state still ranks among the bottom 10 with 2.9 insurers per 1,000 physicians. New Jersey does not have a medical liability cap on non-economic damages or additional liability protections for EMTALA-mandated emergency care.
Despite New Jersey’s accomplishments regarding Access to Emergency Care, the state still faces numerous challenges in this area. The state ranks last for the number of emergency departments per 1 million people, and despite reporting no hospital closures in 2006, the state saw five hospital closures in 2007 and three more by mid-2008. New Jersey has a below average rate of staffed inpatient beds (333.1 per 100,000 people), and the daily hospital occupancy rate exceeds that of nearly all other states (76.1 per 100 staffed beds are occupied on an average day). Contributing to the state’s access issues are Medicaid fee levels for office visits that are the second lowest in the nation (42.0 percent of the national average), and that have been steadily declining since 2004 (14.4 percent).
Recommendations. New Jersey policymakers need to take immediate action to address the multitude of issues impacting Access to Emergency Care. Hospital closures and high hospital occupancy rates may be contributing to hospital crowding and boarding of patients in emergency departments, which New Jersey’s emergency physicians have identified as growing problems in the state. Physicians have also noted an increase in psychiatric patients being boarded in emergency departments while they await inpatient placement. Although the state’s data reflect a relatively high rate of psychiatric care beds, this does not reflect the more recent hospital closures in 2007 and 2008 noted above.
The state also needs to enact medical liability reforms to help lower liability premiums, encourage additional commercial insurers to enter the market, and reduce incentives for physicians to engage in defensive medicine practices that may reduce liability risks but do not improve quality of care and result in ineffective and inefficient utilization of resources.
Finally, policymakers need to ensure that the state’s Medicaid recipients have sufficient access to needed care by reversing the declining trend in Medicaid reimbursement and raising rates so that they are at least comparable to the national average.