Tennessee outperforms most states for Access to Emergency Care and the Quality and Patient Safety Environment, but ranks last in the nation for Disaster Preparedness.
Strengths. Tennessee’s best performance is in the Quality and Patient Safety Environment. The state has or is working on a stroke system of care, as well as a PCI network or STEMI system of care, and provides funding for a state EMS medical director position. The state also requires adverse event and hospital-based infections reporting. While the state data report 5.2 emergency medicine residents per 1 million people, these data were collected prior to the approval of a new emergency medicine residency program at the University of Tennessee Health Science Center.
While the state receives a mediocre grade for Access to Emergency Care, Tennessee has a relatively low rate of uninsured children (6.4 percent). In addition, Tennessee has the highest rate of accredited chest pain centers (4.5 per 1 million people) and ranks 11th for its high rate of staffed inpatient beds (414.0 per 100,000).
Challenges. Tennessee receives a relatively low level of federal funding for Disaster Preparedness which may have contributed to the state’s failing performance in this category. The state does not track disaster preparedness funds used specifically for health care-related preparedness. While the state has an all-hazards medical response plan or ESF-8 plan, that plan is not shared with all professional and volunteer EMS and essential hospital personnel. Tennessee also lacks written plans for special needs patients and to supply medications for chronic conditions or dialysis to patients during a disaster. In addition, Tennessee does not have the ability to verify credentials of volunteer health professionals and to assign them to one of four levels in a state-based Emergency System for Advance Registration of Volunteer Health Professionals program.
Access to Emergency Care suffers from low Medicaid reimbursement rates for office visits (62.0 percent of the national average) and a lack of emergency physicians and mental health care providers. Tennessee has only 8.9 emergency physicians per 100,000 people and needs an additional 60.2 full-time equivalent mental health care providers to serve the state’s population. These issues may contribute to hospital crowding and patient transfers, problems that have been identified as priorities among emergency physicians in the state.
Public Health and Injury Prevention indicators pose serious challenges for Tennessee. The state has among the highest rates of infant mortality in the nation (8.9 deaths per 1,000 births), as well as high percentages of obese adults (28.8 percent) and adults who smoke (22.6 percent). The state also has relatively high fatal injury rates: 22.7 homicides and suicides per 100,000 people and 2.2 deaths due to unintentional fire- and burn-related injuries per 100,000.
The Medical Liability Environment in Tennessee suffers from the lack of a medical liability cap on non-economic damages, periodic payments of malpractice awards, and additional liability protections for EMTALA-mandated emergency care. The state also could build upon existing expert witness rules by providing for expert witnesses to be licensed in the state.
Recommendations. Tennessee should take steps to enhance its preparedness for disasters by ensuring that all disaster plans are shared with appropriate personnel and implement a “just-in-time” training system to complement the real-time notification system that is already in place. The state also could benefit from developing state or regional strike teams or medical assistance teams, as well as a statewide victim tracking system.
The state faces significant challenges in public health, especially related to health risk factors among the population. Health promotion activities (focused on areas such as obesity, smoking, and injury prevention) might significantly improve the health of the population.
Tennessee might improve access to care and its liability climate by providing additional liability protections for EMTALA-mandated emergency care, which could help encourage more specialists to provide on-call services to emergency patients. In addition, increasing Medicaid reimbursement rates might help attract and keep physicians in Tennessee, as well as provide increased access to care for the state’s Medicaid population.