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Report Card: D+ for US Emergency Care

Report Card: D+ for US Emergency Care


With the Affordable Care Act coming of age this year, all eyes are turning to see what impact it will have on the emergency department. There are two schools of thought on the subject. One believes that increased insurance coverage will lighten the load on emergency rooms. Others think the people that now have insurance, some for the first time, will be more likely to seek ER help, increasing the burden. Although the reports are mixed, one stands out, and it claims emergency medical care in the United States is failing to make the grade.

D is Barely Passing

The American College of Emergency Physicians recently downgraded overall emergency department care in the U.S., taking it from the “C-“ of 2009 to a near failing “D+.” The study looks at the various components of the ER system state by state. The purpose is not to single out any one hospital, but to show overall how the state and federal agencies are handling the challenge.

The study used information from the Centers for Disease Control and Prevention along with data taken from Medicaid and Medicare. The panel broke the report down into sections.

  • Access to emergency care
  • Quality and patient safety environment
  • Medical liability environment
  • Public health and injury prevention
  • Disaster preparedness

The grades per state varied. The District of Columbia topped the list with a B-. Other top achievers included:

  • Massachusetts
  • Maine
  • Nebraska

The lowest performer is Wyoming – providing the only “F.”

One of the biggest concerns is what the panel calls defensive medicine. Doctors are overly cautious because of the fear of being sued. The ACEP also states physicians are not keeping on top of prescription drug use, raising the number of emergency department visits from drug seekers and abusers. Even the quantity of ERs is falling – down 11 percent over five decades – showing an escalating trend.

The Aftermath of Obamacare

Some of the negativity surrounding emergency rooms are due to overcrowding with the average wait around 4.5 hours. One of the selling points for Obamacare was opening up ERs for emerging cases by alleviating that burden. Currently, the emergency department serves as a primary care center for the uninsured. It was originally believed more people would go to the doctor if they had insurance. Studies are showing that might not be true. Data indicates that Medicaid patients are just as likely to seek help at the ER as those without insurance, because it is more convenient than a primary care physician.

Recommendations by the American College of Emergency Physicians

Along with the report card, the ACEP offered some advice on improving emergency care in the U.S.

  • Protect emergency departments by providing an adequate workforce and increasing their capacity.
  • Support programs that understand how critical emergency care is to the public.
  • Reduce the crowding in ER environments with other options like urgent care centers.
  • Reform medical liability laws at both the state and federal level
  • Regionalize emergency services
  • Devote funding to disaster management preparedness.
  • Continue to increase metric systems to measure quality.
  • Enhance state laws to reduce the number of preventable deaths and injuries, especially traffic related trauma.
  • Expand standardized state and federal prescription drug monitoring programs.
  • Fund medical education in emergency care to increase ER physicians in poor and rural areas
  • Support emergency medicine research to improve care standards.

The emergency department is a key player in the medical landscape. As the ACEP points out in their report, it is the foundation for trauma and acute illness, public health and disaster response. A poor grade like this one affects every sector of the healthcare industry.


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