Rhode Island ties for second overall, due to high scores in all categories with the exception of the Medical Liability Environment, for which the state received a failing grade.
Strengths. Rhode Island’s grade with regard to Access to Emergency Care is due in part to an extensive workforce. Rhode Island has the second highest rate of emergency physicians per capita (18.4 per 100,000 people) and similarly high rates of specialists such as neurosurgeons (2.7 per 100,000) and orthopedists and hand surgeons (12.9 per 100,000). While the state has only one Level I or II trauma center per 1 million people, virtually the entire population of the state (99.9 percent) lives within 60 minutes of a Level I or II trauma center. The state has the third lowest percentage of uninsured adults and the lowest percentage of uninsured children in the country (9.9 and 4.1 percent, respectively). However, with the recent cuts to the State Children’s Health Insurance Program (SCHIP), Rhode Island has now eliminated coverage for 1,000 low-income parents, and the number of uninsured children is expected to rise dramatically in the next year.
Rhode Island fares better than most states with regard to the Quality and Patient Safety Environment, despite not providing funding for quality improvement within the EMS system. This good performance is due to a number of factors, including the relatively high rate of emergency medicine residents (44.4 per 1 million people) and a funded state EMS medical director position. The state also maintains a statewide trauma registry and has or is working on a stroke system of care and a PCI network or STEMI system of care.
High immunization rates among older adults, adequate funding for injury prevention programs, and the low rates of fatal occupation injuries and homicides and suicides, all contribute to Rhode Island’s strong performance in Public Health and Injury Prevention.
Challenges. The Medical Liability Environment in Rhode Island is among the worst in the nation. The state suffers from a high rate of malpractice award payments (4.0 per 100,000 people) and lacks many significant medical liability reforms. For example, Rhode Island lacks any medical liability cap on non-economic damages, joint and several liability reform, and pretrial screening panels. In addition, the state’s average annual medical liability insurance premium for specialists ($82,426) is significantly higher than the average across the states ($65,489).
While Rhode Island fares well with regard to Disaster Preparedness overall, there are some aspects of preparedness that could be significantly improved. While the state is capable of verifying the credentials of volunteer health professionals and assigning them to one of four levels within the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program, Rhode Island has relatively low rates of nurses and physicians registered in ESAR-VHP (45.4 and 4.7 per 1 million people, respectively). Anecdotal evidence suggests that many nurses and physicians are unaware that they can register in the system.
Recommendations. Despite Rhode Island’s superior grade in Access to Emergency Care, the state faces numerous issues with regard to Medicaid reimbursement. The state ranks 49th for its low Medicaid fee levels for office visits (less than 50 percent of the national average) and has experienced a 21.0 percent decline in Medicaid reimbursements for office visits from 2004 to 2007. This issue should be addressed to maintain and improve Medicaid recipients’ access to quality care.
Emergency physicians in the state identified a severe lack of on-call specialists as a priority concern, despite the relatively high rates of specialists living in the state. As a first step to addressing this issue, Rhode Island should consider implementing medical liability reforms aimed at reducing medical liability risk. The state could provide additional liability protections for all EMTALA-mandated emergency care and implement a medical liability cap on non-economic damages or pretrial screening panels.
While Rhode Island has an above average number of psychiatric care beds (37.2 per 100,000 people), the state has a shortage of mental health professionals and a relatively high percentage of the population with an unmet need for substance abuse treatment (9.3 percent). A lack of resources for psychiatric care and substance abuse treatment may contribute to such problems as psychiatric holds in the emergency department. Again, addressing the state’s medical liability issues and increasing the pool of on-call specialists, including psychiatrists, may help to alleviate this issue somewhat.