PA gets high emergency support grades

Workforce shortages, a poor medical liability environment, threaten state’s high ranking Harrisburg — Pennsylvania received an overall grade of C+ and tied for 8th in the nation, according to a new National Report Card on the State of Emergency Medicine, released Dec. 9 by the American College of Emergency Physicians (ACEP). Despite its above-average grade, the Report Card shows a need for the state to recruit and retain an adequate medical workforce and create a more favorable medical liability environment. The Report Card comes at the time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations. Not enough providers or health insurance The state’s grade of C- and low national ranking in the Access to Emergency Care category is related to the state’s need for primary care and mental health providers, high hospital occupancy rates, and low Medicaid reimbursement rates for office visits. . “Recruiting and retaining an adequate workforce is becoming of utmost importance as the physician population in Pennsylvania ages,” said John Joseph Kelly, DO, president of the Pennsylvania Chapter of ACEP. High medical liability costs hurt The low point of Pennsylvania’s Report Card was in the category of Medical Liability Environment where it received a grade of D- and a national ranking of 38th. The factors behind this grade revolve around high medical liability payments ($415,167 vs. the national average of $285,218) and medical liability insurance premiums for primary care physicians and specialists, which are among the highest in the nation. In addition, Pennsylvania had established a program called MCARE, which provided physicians with half of their required liability insurance coverage and discounted premiums up to 100 percent for certain high-risk specialists. Authorization for the MCARE fund was allowed to lapse in 2008, and although the future of the program was unclear at the time of this report, failure to revive it or to responsibly phase it out will increase physician premiums by thousands of dollars and lead to more physicians leaving the state. An A for public health and injury prevention Pennsylvania fared well in the category of Public Health & Injury Prevention with a grade of B-. However, the state has a high rates of infant mortality, smoking and binge drinking among adults. Additionally, there is no mandatory motorcycle helmet law. Good disaster preparedness In the Disaster Preparedness category, Pennsylvania scored another A, ranking fourth in the nation. In fact, the state leads the nation with the numbers of disaster drills and exercises conducted involving hospital personnel, equipment, or facilities. The state still lacks a written plan to supply medications or dialysis to patients with chronic medical conditions. While Pennsylvania’s emergency system does have an all-hazards medical response plan, the plan is not shared with all EMS and essential hospital personnel. High grades for patient safety Pennsylvania received a second A for its Quality & Patient Safety Environment, also ranking fourth in the nation. The state funds quality improvement in its EMS system and a state EMS medical director. Pennsylvania also has implemented a statewide trauma registry and has a uniform system for providing pre-arrival instructions. Around the country The nation’s failure to support emergency patients resulted in a C- for the country overall. Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-. The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades. “The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP. “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform. We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are a health care safety net for us all.” Pennsylvania tied with Kansas for the 8th place ranking. The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card. The five Report Card categories (and weightings) are: Access to Emergency Care (30 percent), Quality and Patient Safety Environment (20 percent), Medical Liability Environment (20 percent), Public Health and Injury Prevention (15 percent) and Disaster Preparedness (15 percent). The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation. Report Card categories & PA rankings: Access to Emergency Care (23rd,C- ), Quality and Patient Safety Environment (4th, A), Medical Liability Environment (38th, D-), Public Health & Injury Prevention (17th, B-) and Disaster Preparedness (4th, A).