Wisconsin faces a number of wide-ranging challenges in improving its emergency care environment, particularly in the areas of Public Health and Injury Prevention, the Quality and Patient Safety Environment, and Access to Emergency Care.
Strengths. Wisconsin’s strong performance in Disaster Preparedness is due in part to the planning and infrastructure in place to respond to a disaster event. The state has an ESF-8 plan or all-hazards medical plan that is shared with all EMS and essential hospital personnel, as well as a written plan for special needs patients. The state also supports a relatively high bed surge capacity, has a statewide patient tracking system, and a real-time or near real-time syndromic surveillance system.
While Wisconsin’s grade for the Medical Liability Environment could see significant improvement, the state has made some progress in instituting medical liability reforms. In 2006, the state implemented a $750,000 medical liability cap on non-economic damages after the $350,000 cap was declared unconstitutional in 2005. Wisconsin also is one of only five states that require periodic payments of malpractice awards.
Despite its near-average grade with regard to Access to Emergency Care, Wisconsin has among the lowest rates of uninsured residents in the country: Only 4.9 percent of children and 10.0 percent of adults are uninsured. In addition, the state ranks among the top five with regard to pediatric specialty centers and accredited chest pain centers (7.9 and 2.9 per 1 million people, respectively).
Challenges. Below average Medicaid reimbursement rates contribute to Wisconsin’s mediocre score in Access to Emergency Care. Medicaid rates for office visits are only 80.2 percent of the national average, reflecting a 19.2 percent decrease from 2004 to 2007. Access to mental health and substance abuse treatment may also be of particular concern in Wisconsin. While the state has an average rate of psychiatric care beds (29.3 per 100,000 people), there is a significant shortage of mental health providers throughout the state. Specifically, Wisconsin needs an additional 82.8 full-time equivalent mental health providers for its underserved population. The state also has the nation’s highest percentage of people needing and wanting substance abuse treatment but unable to receive it (10.2 percent).
Nearly 25 percent of Wisconsin adults are binge drinkers, the highest of any state, and a correspondingly high percentage of traffic fatalities are alcohol related (50.0 percent). The state also ranks 50th for unintentional fall-related fatal injuries (14.6 per 100,000 people).
Wisconsin’s poor performance in the Quality and Patient Safety Environment was affected by a lack of reporting requirements, such as adverse event and hospital-based infections reporting, and the lack of a uniform system for providing pre-arrival instructions.
Recommendations. Access to medical care is one of the biggest challenges facing Wisconsin. Below average Medicaid fee levels for office visits threaten to increase barriers to preventive care and treatment among the 7.4 percent of adults in the state who are insured through Medicaid. Emergency physicians in the state are reporting an increase in the number of Medicaid patients seeking care in emergency departments, as Medicaid reimbursement rates are decreasing. Increasing Medicaid fee levels will be an important step in enhancing access to care and protecting Wisconsin’s health care safety net.
The state could work to improve the Quality and Patient Safety Environment by instituting reporting requirements and considering the development of a STEMI system of care. Wisconsin patients could also benefit from the implementation of a uniform system for providing pre-arrival instructions.
Wisconsin could also assist in improving the preparedness of its front line personnel by requiring training in disaster management and response to bio- and chemical terrorism for all EMS personnel and essential hospital personnel. While many may already be knowledgeable in these areas, this would ensure that EMS and essential hospital personnel are provided with appropriate and up-to-date training to prepare them for disaster events.
Finally, the state needs to explore programs to address alcohol and other drug abuse issues, specifically addressing the need to move acute patients into more long-term care programs to improve the effectiveness of overall treatment.