Nation's Failure To Support Emergency Patients Graded C- In National Report Card; 90 Percent Of States Earn Mediocre Or Near-Failing Grades
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December 9, 2008
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Emergency Care System A "Ticking Time Bomb" Accelerated By The Financial Crisis And Physician Shortages
Washington, DC —Economic woes and a failing health care system mean more people than ever before are relying on emergency care at a time when the nation is receiving a substandard C- grade for it support of emergency patients, according to a new Report Card on the State of Emergency Medicine. Dr. Nicholas Jouriles, president of the American College of Emergency Physicians (ACEP), which released the report, said policymakers can no longer remain oblivious to what is happening in emergency departments and called on President-elect Obama and the new Congress to make emergency patients a top priority in health care reform proposals.
“Emergency medical care is the most overlooked part of our health care system, and also the one everyone depends on in their hours of need,” said Dr. Jouriles. “Policymakers must make strengthening emergency departments a national priority. The role of emergency care has never been more critical to this nation. It is an essential community service that can no longer be taken for granted. Ninety percent of the states earned mediocre or near-failing grades! That is a national disgrace. The nation’s emergency physicians have diagnosed the condition and prescribed the treatment. It’s time to get serious and take the medicine.”
States that showed the best support for emergency patients are Massachusetts, which ranked first with the highest overall grade and the only B, followed by the District of Columbia and Rhode Island (tied for 2nd) and Maryland (ranked 4th), which earned a B-. States showing the least support for emergency patients are Arkansas, which ranked last (51st) with the only overall D-, followed by the D states of Oklahoma (ranked 50th), New Mexico (ranked 49th), Oregon (ranked 47th) and Idaho ranked 46th).
The Report Card measures state support for emergency patients — not the quality of care provided at specific emergency departments or hospitals. The national category grades are: Access to Emergency Care: D-, Quality and Patient Safety: C+, Medical Liability Environment: C-, Public Health and Injury Prevention: C, and Disaster Preparedness: C+.
ACEP’s first Report Card was released in 2006, and it contained 50 measures in four categories. The new Report Card has more than double the measures (116) and a new category for disaster preparedness, which makes it more comprehensive and useful, but not directly comparable to the previous Report Card. The Report Card 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.
Dr. Angela Gardner, ACEP’s president-elect, said the focus of health care reform has been on the distant future at the expense of the right here, right now, and that emergency care represents only about 2 percent of health care spending in America.
“The emergency care system is a ‘ticking time bomb,’ accelerated by the financial crisis, plus physician shortages that won’t be solved for at least a decade,” said Dr. Gardner. “Economic woes and a failing health care system mean more people than ever before will be relying on emergency care Meanwhile, every minute of every day in this country people need emergency medical care, and that need is growing our population ages and lives longer. Emergency departments are already crowded to the point where patients experience life-threatening delays in care. With crowding forecasts described as ‘catastrophic’ in the near future, the time for action is now.”
The Report Card makes eight national recommendations from a blue-ribbon panel of experts with expertise in areas including hospital emergency care, public health, disaster preparedness, injury prevention and emergency medical services. Each state Report Card contains recommendations specific to each state. The national recommendations are:
- Create stronger emergency departments through national health care reform.
- Alleviate boarding in emergency departments and hospital crowding.
- Pass the Access to Emergency Medical Services Act.
- Enact federal and state medical liability reforms.
- Infuse a greater level of federal funding and support into disaster preparedness targeted for medical preparedness and response.
- Increase support for the nation’s health care safety net.
- Develop greater coordination of emergency services.
- Increase the use of systems, standards and information technologies to track and enhance the quality and patient safety environment.
The five Report Card categories (and weightings) are:
- Access to Emergency Care (30 percent) — the District of Columbia ranked first, and California ranked last. This category contains 26 measures that include the number of emergency physicians and percent of population without health insurance. New measures (since the 2006 Report Card) include the number of nurses and on-call specialists (e.g., surgeons, orthopedists), percent of physicians accepting Medicare, hospital closures in 2006 and staffed inpatients beds. Other new measures assess what percent of the population live within 60 minutes of a trauma center and whether additional primary care or mental health services are needed in the state.
- Quality and Patient Safety Environment (20 percent) — Washington State ranked first, and South Dakota ranked last. This category contains 15 measures. New measures include whether the state funds quality improvement of the state’s EMS system, requires reporting for adverse events and hospital-based infections or funds a state EMS medical director. Also included is whether the state has (or is working on) emergency cardiac and stroke systems of care and the percent of hospitals using computerized practitioner order entry and electronic medical records.
- Medical Liability Environment (20 percent) — Colorado ranked first, and the District of Columbia ranked last. This category contains 21 measures that include whether the state has caps on non-economic damages, uses pre-trial screening panels or has abolished joint and several liability. New measures include average malpractice payments and the average medical liability insurance premiums of primary care physicians and medical specialists. This category also assesses the number of lawyers (not included in the grading).
- Public Health and Injury Prevention (15 percent) – Massachusetts ranked first, and Louisiana ranked last. This category contains 23 measures that include the percent of alcohol-related traffic fatalities and seat belt use, as well as motorcycle helmet use. New measures include whether states have child safety seat legislation and the percent of the population that are obese, smoke and engage in binge drinking. In addition, new measures include what percent of tobacco settlement funding is spent on health-related services and programs and the number of homicides and suicides.
- Disaster Preparedness (15 percent) — the District of Columbia ranked first, and Tennessee ranked last. This new category has 31 measures that include how much federal disaster preparedness funds are spent per capita for medical preparedness and whether an all-hazards medical response plan is being used. It also includes whether the state planning process involves input from emergency physicians and whether plans are in place for patients with special needs, such as those who need medications or dialysis. In addition, it assesses whether the state has a real-time notification system (to notify health care providers of a disaster), a statewide patient tracking system, a statewide victim tracking system or a real-time (or near real-time) syndromic surveillance system. This category also assesses whether physicians and nurses are trained to respond to disasters, the state’s bed surge capacity and the number of ICU and burn unit beds. It also assesses whether there are liability protections in place for health care workers during a disaster.
The national grades are based on population-weighted averages for each of the categories, calculated using the same methodology used to calculate the overall state grades. The overall grade for the nation is a weighted average of the nation’s category specific grades.
ACEP is 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.