Virginia scores high marks in Disaster Preparedness and has invested in both patient safety and injury prevention. However, low numbers of emergency departments per capita, a shortage of nurses, and a lack of physicians participating in the Medicare program may indicate significant problems in Access to Emergency Care.
Strengths. Virginia is rated highly in Disaster Preparedness, ranking among the top five states for the number of volunteer nurses and physicians registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program (369.5 and 107.1 per 1 million people, respectively). The state also has civil liability protections for health care workers during a disaster event. In addition, the state has a written plan specifically for patients with special needs, as well as plans to supply medications for chronic conditions and dialysis for patients during a disaster. Virginia also is one of only 17 states to be accredited by the Emergency Management Accreditation Program.
The state also managed noteworthy successes with regard to the Quality and Patient Safety Environment. For instance, Virginia is developing a stroke system of care, as well as a PCI network or STEMI system of care. The state also maintains a statewide trauma registry and provides funding for quality improvement within the EMS system as well as a state EMS medical director position. Virginia also has a slightly higher than average rate of emergency medicine residents (13.1 per 1 million people).
Virginia fares quite well with regard to Public Health and Injury Prevention. The state ranked among the top 10 states in all areas of injury prevention funding, with total injury prevention funds of $636.40 per 1,000 people, unintentional injury prevention funds of $345.78 per 1,000, and intentional injury prevention funds of $282.57 per 1,000. In addition, the state has a relatively low rate of unintentional fall-related fatal injuries (4.8 per 100,000).
Challenges. Access to Emergency Care remains an issue in Virginia. The state ranks among the worst 10 states for low rates of physicians accepting Medicare (2.5 per 100 beneficiaries) and emergency departments (8.5 per 1 million people). Virginia also has a below-average rate of registered nurses (755.7 per 100,000 people).
While Virginia has made strides in the area of medical liability reform, including voluntary pretrial screening panels whose findings are admissible as evidence and requiring that expert witnesses be of the same specialty as the defendant, the state still lacks some important reforms. Virginia has not abolished joint and several liability. The state also lacks additional liability protections for EMTALA-mandated emergency care, and there is no requirement or provision for expert witnesses to be licensed in the state.
Recommendations. Virginia needs to improve access to health care for the uninsured and underinsured. The state must also ensure that Medicaid reimbursement policies are not unfairly reducing payment for emergency care that is deemed non-emergent after care has already been provided. While no hospitals have closed since the last Report Card, there are fewer emergency departments per 1 million people and fewer nurses to care for patients. This may represent a market decision not to expand emergency services because of concerns of inadequate compensation.
Virginia also could improve its standing with regard to the Quality and Patient Safety Environment by developing and implementing a uniform system for providing pre-arrival instructions and increasing the percentage of hospitals with computerized practitioner order entry.
Virginia should focus on implementing specific medical liability reforms, including additional liability protections for EMTALA-mandated emergency care and a patient compensation fund, in addition to maintaining the Neurological Birth-Related Injury Compensation Program. The state should pursue reform efforts to reduce liability insurance premiums and increase the low rate of insurers writing medical liability policies (3.5 per 1,000 physicians).
Finally, while Virginia fares well in Disaster Preparedness, the state would benefit from increasing the number of intensive care unit beds available to accommodate victims of a major disaster (225.9 beds per 1 million people, compared with the average across the states of 299.0 per 1 million).