Emergency physicians sounded a warning that a continuing failure of state and national policies is endangering emergency patients, citing as proof a grade of D+ in the latest edition of a state-by-state report card on support for emergency care.
The report card, issued by the American College of Emergency Physicians, forecasts an expanding role for EDs under the Affordable Care Act and describes the harmful effects of the competing pressures of shrinking resources and increasing demands. The report card measures conditions and policies under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers.
Congress and President Obama must make it a national priority to strengthen the emergency medical care system, Alex Rosenau, DO, president of ACEP, said in a news release. There were more than 130 million emergency visits in 2010, or 247 visits per minute.
People are in need, but conditions in our nation have deteriorated since the 2009 report card due to lack of policymaker action at the state and national levels. With so much changing in healthcare, emergency care has never been more important to our communities. This report card is a call to action.
In 2009, the last time ACEPs report card was issued, the U.S. earned an overall grade of C-. According to Rosenau, the lower grade in 2014 also reflects a misguided focus on cutting resources for EDs because of the popular but misguided view that emergency care is expensive, even though it comprises less than 5% of overall healthcare costs.
Americas Emergency Care Environment: A State-by-State Report Card has 136 measures in five categories:
Access to emergency dare (30% of the grade): the nation received a D-
Quality and patient safety (20%): C
Medical liability environment (20): C-
Public health and injury prevention (15%): C
Disaster preparedness (15%): C-
Washington, D.C., ranked first in the nation with a B-, surpassing Massachusetts, which held the top spot in the 2009 report card. Wyoming ranked last with an F.
The top-ranked states were D.C. (B-), Massachusetts (B-), Maine (B-), Nebraska (B-) and Colorado (C+).
The bottom-ranked states were Wyoming (F), Arizona (D-), New Mexico (D), Montana (D) and Kentucky (D).
According to Jon Mark Hirshon, MD, MPH, chairman of the task force that directed development of the report card, the national grade for Access to Emergency Care has not improved since 2009.
Americas grade for ‘Access to Emergency Care’ was a near-failing D- because of declines in nearly every measure, Hirshon said in the news release. It reflects that hospitals are not getting the necessary support in order to provide effective and efficient emergency care. There were 19 more hospital closures in 2011, and psychiatric care beds and hospital inpatients beds have fallen significantly, despite increasing demand.
People are increasingly reliant on emergency care, and primary care doctors are advising their patients to go to the emergency department after hours to receive complex diagnostic workups and to facilitate admissions for acutely ill patients.
The report card includes national recommendations, and ACEP is asking Congress to take actions, such as the following:
Fund the Workforce Commission, as called for by the Affordable Care Act, to investigate shortages of physicians, nurses and other healthcare professionals.
Pass the Health Care Safety Net Enhancement Act of 2013, H.R. 36, introduced by Rep. Charlie Dent, R-Pa., and the companion legislation, S. 961, introduced by Sen. Roy Blunt, R-Mo. This legislation would provide limited liability protections to physicians emergency and on-call who perform the services mandated by the federal EMTALA law, which requires emergency patients to be screened, diagnosed and treated, regardless of their insurance status or ability to pay.
Fund pilot programs, provided for in the ACA, to design, implement and evaluate innovative models of regionalized, comprehensive and accountable emergency care and trauma systems.
Support and fund the mission of the Emergency Care Coordination Center at the Department of Health and Human Services to create an emergency care system that is patient- and community-centered, integrated into the broader healthcare system, high-quality and prepared to respond in times of public health emergencies.
Withhold federal funds to states that do not support key safety legislation, such as motorcycle helmet laws and 0.08 blood alcohol content laws.
Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged and rural areas.
Support efforts to fund emergency care research by the new Office of Emergency Care Research under the National Institutes of Health.
Hold a hearing to examine whether additional strains are occurring in the emergency department safety net as a consequence of the Affordable Care Act.
Report card: www.emreportcard.org