The American College of Emergency Physicians has released its 2014 report card and the grade of the United States might give its citizens a heart attack. ACEP gave the U.S. an overall score of D+ for the overall environment of emergency care in the country. The results indicate a worsening access of people to emergency care that might save their lives. In 2009, the country received a C-.
The ACEP is the largest organization of doctor who practice emergency medicine. The group monitors healthcare trends and focus on issues that affect emergency physicians. The first report from ACEP was issued in 2006 with the goal of improving emergency care. It looks into conditions of field and policies affecting delivery of effective emergency care to patients.
For the 2014 report, the country received subpar grades in the categories of "Access to Emergency Care" where it got a D- (D- in 2009); "Medical Liability" where it received C- (C- in 2009); and "Disaster Preparedness" where it was given a C- (C+ in 2009). The overall score for "Public Health/Injury Prevention" was pegged at C, same as in 2009. The "Quality/Patient Safety" category showed a drop from the 2009 grade of C+ in 2009 to just C for the new report card.
To emphasize the decline in the quality of emergency care nationwide, 21 states got Fs in the category of Access to Emergency Care, 13 states were given Fs for Disaster Preparedness, 10 states also received failing marks in Public Health and Injury Prevention. Ten states were also given Fs for Quality and Patient Safety and 10 were also given Fs for Medical Liability Environment.
"Congress and President Obama must make it a national priority to strengthen the emergency medical care system.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 health care, emergency care has never been more important to our communities. This Report Card is a call to action," said ACEP president Dr. Alex Rosenau in a statement.
Is it okay to have a heart attack in your state?
If someone is having a stroke, a heart attack, or got hit by a car, will your state be able to save you? While it will be on a case to case basis, the grades given by ACEP to each state gives one a good picture of where not to have a life-threatening event, if that can only be a controllable variable in life.
In 2009, the grades of individual states ranged from B to D-. The status of emergency care declined since then with a grade between B- and F received by the states for 2014.
The District of Columbia topped the overall ranking with a grade of B-, overtaking Massachusetts that bested all states in 2009. Maine, Nebraska, Colorado, Pennsylvania, Ohio, North Dakota, Utah, and Maryland completed the top 10.
At the other end of the spectrum, Wyoming got an F. It is followed by Arkansas, New Mexico, Montana, Kentucky, Michigan, Illinois, Alabama, Alaska, and Louisiana to complete the bottom 10.
Are we approaching the flat line?
"America's grade for Access to Emergency Care was a near-failing D- because of declines in nearly every measure. 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 physicians 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," said Dr. Hirshon, who led the task force that developed the report card.
The different states have been struggling with different issues such as workforce shortages, long wait times at emergency rooms, limited capacity to meet demands, and financial barriers.
ACEP also came up with a list of recommendations to improve emergency care in the United States:
Fund the Workforce Commission, as called for by the Affordable Care Act (ACA), 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 Senator Roy Blunt (R-MO). This legislation would provide limited liability protections to (emergency and on-call) physicians who perform the services mandated by the federal EMTALA law, which requires emergency patients 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 H.H.S. to create an emergency care system that is patient- and community-centered, integrated into the broader health care 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 .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.
