Massachusetts Ranks First in the Nation for Its Support of Emergency Patients
in National Report Card on State of Emergency Medicine
 

State Earns B Grade Overall, Despite D Grade in
Medical Liability Environment Category

Waltham, MA — Massachusetts ranks first in the nation for its support of emergency patients, earning a B and showing particular strength in the categories of Public Health & Injury Prevention, Access to Emergency Care and Quality & Patient Safety Environment, according to a new Report Card released today by the American College of Emergency Physicians (ACEP).. The high grade notwithstanding, Massachusetts still must make significant improvements in the area of Medical Liability Environment if its emergency care system is to remain strong.

The Report Card comes at the time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.

The Medical Liability Environment of Massachusetts is in desperate need of reform. ACEP's Report Card placed the state's liability environment at a below-average national ranking of 33rd with a grade of D due primarily to the astronomical average malpractice award amount of $437,000, compared to the national average of $285,218. Massachusetts also has the fourth lowest number of insurers writing liability policies – just 1.9 per 1,000 physicians.
    
“Massachusetts must enact appropriate medical liability reforms to decrease insurance premiums, and, above all, to encourage specialists to be available on-call for what are generally high-risk cases in the emergency department,” said James A. Feldman, MD, president of the Massachusetts College of Emergency Physicians.   “If you have a stroke and there are no neurologists willing to take call in the emergency department, your care may be delayed by precious minutes or even hours.”
                
Massachusetts received a grade of B and a national ranking of 19th in Disaster Preparedness. The state scored well in regard to planning, coordination, tracking systems, burn treatment capacity and surveillance. Massachusetts also ranks among the top 10 for enrollment of physicians and nurses in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program. However, the state lacks liability protection for alternative standards of care in the event of a disaster and does not have well-defined plans for patients with special needs.

“We do require some training in response to bio and chemical terrorism for all EMS providers; however there is no standardized training requirement for all EMS and other essential hospital personnel,” said Dr. Feldman.  “This is an area for improvement.”

Massachusetts fared well in the category of Access to Emergency Care where it received a grade of B and a national ranking of 3rd. The state has had a relatively low uninsured rate among the state's children and adults (11.4 and 7.0 respectively), and these rates have dropped even further since the implementation of Massachusetts' universal health insurance mandate. State officials should be commended for pushing initiatives that will effectively end the practice of ambulance diversion in January 2009. On the down side, the state faces a high hospital occupancy rate of 75.4 per 100 staffed beds and a comparatively low 9.8 emergency departments per 1 million people.

Massachusetts' Quality & Patient Safety Environment earned an A and a national ranking of 6th. The system has excellent quality control and improvement systems in place or under development, such as a statewide trauma registry and a stroke system of care.
 
In the category of Public Health & Injury Prevention, Massachusetts received another A and came in first. Massachusetts consistently ranks among the top in the nation for numerous public health and injury prevention measures, including childhood immunization rates of 87 percent, 73.1 percent of adults over 65 receiving flu vaccinations and 70.8 percent of that same group receiving pneumococcal vaccines. The state has low incidents of fatal unintentional injuries, obesity, adult smoking, traffic fatalities and the fourth lowest infant mortality rate in the nation.

“Massachusetts has done many things to support its emergency patients, but there is still work to be done,” said Dr. Feldman.  “Shortages of primary care physicians and specialists who take call in the emergency department are a growing problem.  These and other factors, such as emergency patient boarding, create dangerous levels of crowding in many Massachusetts emergency departments.”

The nation’s failure to support emergency patients resulted in a C- for the country overall.  Arkansas ranked last (51st) in the nation with a D-.  The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.

“The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP.  “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform.  We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are a health care safety net for us all.”

The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than  twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card. 

The five Report Card categories (and weightings) are:  Access to Emergency Care (30 percent), Quality and Patient Safety Environment (20 percent), Medical Liability Environment (20 percent), Public Health and Injury Prevention (15 percent) and Disaster Preparedness (15 percent).

The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

The Massachusetts College of Emergency Physicians is a state chapter of ACEP, a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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