Latest ACEP national, state-level report cards cite ample room for improvement
ACEP leaders urge emergency providers to use findings to advocate for positive change
Executive Summary
In its latest round of report cards on the emergency care environment, the American College of Emergency Physicians (ACEP) gave the nation an overall ranking of D+, a slight decline from the rankings unveiled in 2009. Overall state-level rankings were also unveiled, as well as individual rankings for access, quality and safety, medical liability environment, public health and injury prevention, and disaster preparedness. Leaders at ACEP urge providers to use the rankings to advocate for change in their states; however, there is concern that the report cards are already being misinterpreted as being a reflection of care quality rather than the emergency care environment.
- Notably, on the national report card, access to emergency care received an overall grade of D-, and it accounted for 30% of the overall grade.
- Among the state-level rankings, Washington, DC, Massachusetts, Maine, and Nebraska were the top performers, earning an overall grade of B-.
- At the other end of the spectrum, Wyoming received an overall grade of F, Arizona received a D-, and Montana, New Mexico, and Kentucky each received a grade of D.
The American College of Emergency Physicians (ACEP) has issued what the group is terming a call to action to state and national policy makers on emergency care. In its latest report card on the emergency care environment, ACEP finds that conditions have declined since the last report in 2009. Today, while some individual states have made progress in certain areas, ACEP says overall conditions and policies under which emergency care is delivered in this country get a grade of D+ — down slightly from the grade of C- ACEP issued on its national report card in 2009.
The lower grade reflects what ACEP President Alex Rosenau, DO, FACEP, calls a "misguided focus" on slashing resources for emergency care because of the widely held view that emergency care is expensive. In reality, Rosenau points out that emergency care is a very cost-effective element American health care, and makes up less than 5% of health care costs.
Further, with demand for emergency services expected to increase as more Americans gain coverage under full implementation of the Affordable Care Act (ACA), ACEP is urging policymakers to prioritize the strengthening of America's emergency care system.
"The ACEP report card is very important to the American community, whose members rely on the emergency care system for all forms of care, and as a safety net. This comes from the success of the prevention and public health components of the emergency system in preventing premature death," explains James Augustine, MD, FACEP, executive editor of ED Management, a member of the board of directors of ACEP, and director of clinical operations for Emergency Medicine Physicians in Canton, OH. "Both primary care and specialty physicians rely on the ED to provide complex diagnostic workups, to initiate care, and to facilitate the admission of about 68% of inpatients."
Augustine adds that the report highlights the difficulties that both federal and state leaders have in allocating resources for emergency services and in addressing quality and patient safety, the burden of medical liability, and preparedness for disasters and other major incidents. "We look to discussions around the report card for assistance to the emergency system. The providers are dealing with patient boarding, the burden of mental health and chemical dependence patients in the ED, workforce stress, and the implementation of unfriendly information technology programs, as well as the many difficult financial issues," he adds.
Get the correct message out
To arrive at its conclusions, ACEP considered 136 different measures, and it broke its findings down into five different categories, each of which received an individual grade.
- Access to emergency care received a D- and accounted for 30% of the overall grade;
- Quality and patient safety received a grade of C and accounted for 20% of the overall grade;
- Medical liability environment received a grade of C- and accounted for 20% of the overall grade;
- Public health and injury prevention received a grade of C and accounted for 15% of the overall grade;
- Disaster preparedness received a grade of C- and accounted for 15% of the overall grade.
Further, each state received its own report card rankings. For example, the top performing states included Washington, DC, Massachusetts, Maine, and Nebraska, all of which received an overall grade of B-. At the other end of the spectrum, Wyoming received an overall grade of F, Arizona received a D-, and Montana, New Mexico, and Kentucky each received a grade of D.
State-level ACEP leaders are hoping to use the report card findings to spur policymakers toward providing more support for emergency care. However, a big concern is that rather than viewing the rankings as a reflection on the emergency care environment, various media are instead linking the grades with emergency providers.
"I have already seen this misinterpreted [to mean that] the ACEP was commenting on the quality of the clinical care that was delivered [in the ED], and that was really not our intent. What we really need to message out is that we are commenting on the health care environment that we are practicing in as physicians," stresses Michael Lozano, MD, FACEP, president of the Florida chapter of ACEP.
Florida received an overall grade of C- on the report card, but on access to emergency care specifically, the state received a grade of F, making it 49th in the nation on this metric. Lozano is hoping to use the ACEP findings to advocate for change. "We don't want legislators to fall into the trap of thinking that having an insurance card is the same thing as access," he says. "Our focus is really on educating them that Florida needs to become more of a destination state. We need to become more physician-friendly."
Advocate for change
The latest round of ACEP report cards is, in fact, intended to influence the ongoing policy debate over emergency care while also focusing attention on the feedback loop that EDs have become for social policy, observes Nicholas Vasquez, MD, FACEP, a councillor and past president of the Arizona chapter of ACEP in Phoenix, AZ. "Each ED doc who uses the results of the report card should be focusing their advocacy on the specific policy packages that will improve care in their state," he says.
For instance, while Arizona received a B+ on patient safety and quality of care, which is an improvement over the last round of report cards, its overall ranking of D- is near the bottom. Of particular concern to Vasquez is the lack of providers. There aren't enough providers to meet the current demand, let alone the increased demand from an aging population, he says.
"One clear way to improve the number of providers is to increase the number of residency slots here in Arizona. Studies show many doctors stay in the same state where they trained, so while we are increasing the number of medical students passing through Arizona, we're missing the opportunity to keep them in state by making them go out of state for residency," says Vasquez.
Consequently, Vasquez intends to use the report card findings to push for an increase in state funding to open up more of these slots. "We anticipate that EDs will be busier after [full implementation] of the ACA. We think that GME [graduate medical education] funding is the best way to help find [providers] for people to go to," he says. "What we're asking for is a public investment in the health and welfare of the citizens of Arizona by increasing the number of training slots for doctors."
Editor's note: For more on the ACEP's report card rankings, visit www.emreportcard.org.
SOURCES
- James Augustine, MD, FACEP, Member, Board of Directors, American College of Emergency Physicians, and Director, Clinical Operations, Emergency Medicine Physicians, Canton, OH. E-mail: [email protected].
- Michael Lozano, MD, FACEP, President, Florida Chapter, American College of Emergency Physicians, Orlando, FL. E-mail: [email protected].
- Nicholas Vasquez, MD, FACEP, Councilor and Past President, Arizona Chapter, American College of Emergency Physicians, Phoenix, AZ. E-mail: [email protected]
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