Pennsylvania tied for 8th in the nation overall, receiving high marks for the Quality and Patient Safety Environment and Disaster Preparedness. However, a need for more providers and a troubled Medical Liability Environment may be hindering Access to Emergency Care.
Strengths. Pennsylvania has made a number of noteworthy accomplishments with regard to the state’s Quality and Patient Safety Environment. The state provides funding for quality improvement within the EMS system, as well as a state EMS medical director position. Pennsylvania also has implemented a statewide trauma registry and has a uniform system for providing pre-arrival instructions.
Disaster Preparedness in Pennsylvania ranks fourth best in the country, and the state leads the nation with the numbers of disaster drills and exercises conducted involving hospital personnel, equipment, or facilities (1,535). EMS and essential hospital personnel are required by the state to be trained in disaster management and response to bio- and chemical terrorism. Additionally, the state has medical assistance teams or strike teams in place in the event of a disaster.
Pennsylvania has shown some success with regard to Access to Emergency Care as well. Slightly more than 7 percent of children in Pennsylvania are uninsured and fewer than 11 percent of adults are uninsured, compared with 11.7 and 17.2 percent, respectively, nationwide. In addition, a study conducted by the Commonwealth Fund and the Pennsylvania Insurance Department estimates the actual rate of uninsured adults to be even lower.
Challenges. Pennsylvania’s Medical Liability Environment has improved somewhat, but additional work is needed. Average malpractice awards, or payouts, are among the highest in the nation ($415,167), as are the average medical liability insurance premiums for primary care physicians and specialists ($23,711 and $107,733, respectively). The joint and several liability reform that Pennsylvania previously enjoyed was declared unconstitutional. Further exacerbating the liability problem is the status of the state’s MCARE program, which provides physicians with half of their required liability insurance coverage and discounts premiums up to 100 percent for certain high-risk specialists. Authorization for the MCARE fund was allowed to lapse in 2008, and although the future of the program remains unclear at the time of this report, failure to revive it or to responsibly phase it out will result in physician premiums immediately increasing by thousands of dollars and could lead to more physicians leaving the state.
The state’s grade for Access to Emergency Care was held down by the need for primary care and mental health providers, a high hospital occupancy rate, and low Medicaid reimbursement rates for office visits. Medicaid reimbursement for office visits are only 54.5 percent of the national average, despite a 38.1 percent increase between 2004 and 2007. In Public Health and Injury Prevention, the infant mortality rate is higher than that of the nation (7.3 versus 6.9 deaths per 1,000 live births), as are the rates of smoking and binge drinking among adults.
Recommendations. Recruiting and retaining an adequate medical workforce is becoming of utmost importance as the physician population in Pennsylvania ages. The state should continue increasing Medicaid reimbursement levels for office visits which may encourage more physicians to see Medicaid beneficiaries.
Pennsylvania should work to create a more favorable Medical Liability Environment. As mandated, the state should ensure that the pace of the phase-out of the MCARE program is conducted in a way that won’t further increase the excessively high liability premiums paid by the state’s physicians. The state should also consider additional reforms such as enacting special liability protections for EMTALA-mandated emergency care.
Instituting such reforms might also help increase the number of specialists who are willing to provide on-call services for emergency patients. Emergency physicians in Pennsylvania have reported a severe shortage of on-call specialists as well as significant problems with hospital crowding and boarding of admitted patients in emergency departments. State officials recently began working with the Pennsylvania Chapter of ACEP and other key stakeholders to address this problem and efforts need to continue to effectively resolve the serious consequences related to boarding and crowding.