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Physicians’ group gives U.S. a D Plus for emergency care

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On January 16, the American College of Emergency Physicians (ACEP) gave out grades regarding emergency care. Grades were broken down into various categories and individual state ratings, including the District of Columbia, were also given. The physician group issued an overall rating of D +, marking a decrease from an overall C – grade from the group's last report in 2009. California fared slightly better than the nation, in its overall rating, earning a lackluster C –, which marked a slight improvement from the D + issued in 2009. California was ranked 23 out of 51, overall, placing it about in the middle of the pack. Washington, D.C. was ranked the highest in the report, earning an overall B –; Wyoming ranked last and was the only state to earn an overall failing grade of F. Sadly, the ACEP and a number of healthcare analysts do not believe emergency care will improve in the near future; the influx of patients due to Obamacare, is expected to result in further deterioration of emergency care.

The ACEP’s task force reviewed data from a number of sources, including the Centers for Disease Control and the Centers for Medicare and Medicaid Services. Scores for five major categories were tabulated: access to care, quality/patient safety, medical liability, public health/injury prevention, and disaster preparedness. California received an F for access to emergency care, a C – for quality/patient safety, a B – for medical liability, a B + for public health/injury prevention, and a D + for disaster preparedness. The group noted that, nationwide, shortages and reduced hospital capacity make it more difficult to access emergency care. It also warned about the impact on disaster preparedness.

The report does not factor in all of the effects of the Affordable Care Act because its grades are based on data from early 2013; however, the ACEP predicts that emergency departments wil see increased utilization as more Americans gain insurance coverage under Obamacare. Supporters of the Affordable Care Act are predicting that increasing the number of insured patients should reduce pressure on hospital emergency departments because access to regular doctor care will improve. These proponents believe that this increased access will result in earlier treatment for conditions likely to worsen without intervention.

A study published earlier this month in the journal Science found that expanding Medicaid (MediCal in California increased utilization of emergency department use rather than lowering it. In 2008, Oregon introduced a limited expansion of a Medicaid program for uninsured, low-income adults; names were drawn from a waiting list by lottery. The study authors note that this lottery generated a rare opportunity to assess the effects of Medicaid coverage with a randomized, controlled study (the fact that the lottery recipients were randomly drawn provided randomization). The lottery recipients totaled 25,000 individuals; their use of emergency departments was tracked for a period of 18 months after they were included in the lottery.

Further information regarding the ACEP report card can be found at this link.

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