State and federal lawmakers are doing a dismal job of supporting the nation’s emergency departments, creating poor access to emergency care, a volatile medical liability environment, and providing insufficient resources for disaster preparedness, according to a national and state-level report card from the American College of Emergency Physicians.
The organization gave the nation an overall grade of D+ for its policies on emergency care.
The report does not address the quality of care provided directly by emergency physicians and other providers.
The emergency care environment has worsened over the last few years, ACEP found. In 2009, the last time the college issued a report card, the U.S. earned an overall grade of C-. The lower grade this year is due in part to state-level funding cuts for emergency departments.
"This report card is sounding an alarm. Rhetoric and policy for the past several years has focused primarily on preventing emergency visits. Is it any surprise that our national grade has dropped to a D+?" said Dr. Alex Rosenau, president of the American College of Emergency Physicians.
The report card is also a call to action for Congress and the president, Dr. Rosenau said, because the Affordable Care Act is likely to put an even greater strain on struggling emergency departments.
EDs can expect an influx of patients as millions of Americans are insured for the first time, said Dr. Rosenau, senior vice chair of emergency medicine at Lehigh Valley Health Network in Allentown, Pa. Primary care physician shortages – combined with low Medicaid payments – mean that the ED is likely to be the main source of care for many of these newly insured patients, he said.
"More patients are coming," he said. "We want to be ready."
The report card scores the measures related to access to emergency care, quality and patient safety, the medical liability environment, public health and injury prevention, and disaster preparedness. An ACEP task force analyzed data from the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare and Medicaid Services, and the American Medical Association.
The nation’s lowest grade was for access to emergency care (D–), which examines the number of emergency physicians, access to treatment centers, financial barriers, and hospital capacity. The poor grade reflects recent hospital closures, coupled with the growing shortage of psychiatric care beds and hospital inpatient beds.
In the area of quality and patient safety, which measures the implementation of triage policies, as well as the use of computerized practitioner order entry, the U.S. received a C.
The United States received a C– in the area of medical liability, which examines state tort reform efforts and the general legal atmosphere for physicians.
The country also got a C for policies related to public health, including traffic safety and drunk driving, immunizations, and injury prevention.
Finally, ACEP awarded a grade of C– for disaster preparedness, which includes funding for state coordination and training not only during natural disasters, but also during terrorist events and health outbreaks.
"I am alarmed by the lack of support for emergency care," said Dr. Jon Mark Hirshon, chair of the report card task force who is with the department of emergency medicine at the University of Maryland, Baltimore. "When you need an emergency department, you need it. We must send a clear message to our state and federal legislators to support this crucial part of the health care system."
The report card also graded state-level support of emergency medicine. The District of Columbia earned the highest overall (B-) and was joined in the top five by Massachusetts, Maine, Nebraska, and Colorado. In contrast, Wyoming ranked last, earned a failing grade overall. The other bottom-ranked states were Arkansas, New Mexico, Montana, and Kentucky.
ACEP officials called the report a "roadmap" for improving emergency care in this country. The college called on Congress to:
• Fund the Workforce Commission, created under the ACA, to investigate health provider shortages.
• Pass legislation to provide limited liability protections for emergency and on-call physicians who perform services mandated by the federal Emergency Medical Treatment & Labor Act (EMTALA).
• Fund ACA pilot programs to design innovative models of regionalized emergency care and trauma systems.
• Fund the Emergency Care Coordination Center at the Health and Human Services department.
• Fund graduate medical education program in emergency care.
• Hold hearings to examine how the ACA is impacting the emergency department safety net.
mschneider@frontlinemedcom.com
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