The 2009 ACEP National Report Card on the State of Emergency Medicine is out. If emergency medical care in the US was a patient, in some categories we’d be pulling out the crash cart.
The nation got a “D-” for Access to Emergency Care. ED visits increased by 32% to more than 120 million while the number of EDs in the US decreased by more than 7%. There is a generalized lack of access to nurses, primary care physicians, emergency physicians and specialists. According to a recent New York Times article, more and more uninsured patients are straining already overburdened emergency departments due to the stuttering economy. Similarly, a December article in the Washington Post titled “The Doctor is Out” describes how more and more patients with Medicare are having a difficult time finding a primary care physician. We already know how difficult it is for Medicaid patients to find care. The avenue of last resort leads to us, the emergency physicians. ED volumes will continue to grow, wait times and patient boarding will continue to increase, and access to emergency care will only get worse . . . unless something drastically changes.
Quality and Patient Safety got a “C+” although there weren’t a lot of things able to be measured on a state-by-state basis, so “uniformity” among the state grades suffered. States that did well in this category generally created funded EMS systems and tracked quality measures/adverse events within the state.
The Medical Liability Environment was a “C-” in the US. Some states got high marks. Texas was a shining star, getting an “A” for all of its tort reform measures. The results showed up not only on the report card, but also in applications for licensure within the state. A September 8 article in American Medical News showed that malpractice premiums have dropped 25%, lawsuit filings have dropped 50%, and the number of medical license applications has jumped 58%. The message is clear: Physicians are sick of jackpot jury awards and they are tired of being sued for bad outcomes that have little to do with the care being provided. Some docs choose to retire early or to stop providing high-risk services. Other specialists just stop taking emergency calls. As the AM News article showed, some physicians simply choose to move to states with less liability exposure. If we keep trying to sue physicians for every bad outcome, the doctors will stop practicing, stop seeing high-risk patients, or just move to another state. Some states are having difficulty finding enough doctors to provide medical care. Medical liability and access to care go hand-in-hand.
The nation got a “C” in Public Health and Injury Prevention. According to the Report Card, states just aren’t passing enough laws to protect us from ourselves. We have a long way to go in areas such as drunk driving, immunizations, child safety seat use, and seat belt/motorcycle helmet laws. It is ironic how many people complain about how bad medical care is, but how we don’t do as much as we could to prevent ourselves from getting sick or injured.
Disaster Preparedness got a grade of C+ which was good, but could be better. We need to train more emergency personnel what to do in the event of a disaster and to improve our tracking and surveillance of potential disaster situations. ED overcrowding doesn’t give many hospitals much room for “surge capacity” in the event of a mass casualty.
What can we do to improve the situation? The Report Card has a list of eight national recommendations including alleviating boarding, passing the Access to Emergency Medical Services Act, enacting medical liability reforms, developing more coordination of emergency services, and increasing federal funding for disaster preparedness. In the narratives, the Report Card also makes state-specific recommendations according to each state’s strengths and weaknesses.
All ACEP members will receive a copy of the Report Card which will be the January edition of Annals of Emergency Medicine. For an electronic version of the report card and to compare states on each of the categories, go to www.emreportcard.org