ACEP’s Report Card on America’s Emergency Care Environment

Jon Mark Hirshon, MD, MPH, PhD
Associate Professor, Department of Emergency Medicine
University of Maryland School of Medicine

The American College of Emergency Physicians’ (ACEP) recently released a Report Card on America’s Emergency Care Environment painting an alarming picture of the current state of support for emergency care. Overall, the nation received a D+ for its support of emergency care and emergency patients, with states’ grades ranging from a B- to an F.

The report is based on 136 objective measures that reflect the most recent data available, many from federal government sources, such as the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and Substance Abuse & Mental Health Services Agency (SAMHSA) (see Data Sources). The 136 metrics are divided into 5 categories: Access to Emergency Care (30%); Quality & Patient Safety (20%); Medical Liability (20%); Public Health & Injury Prevention (15%); and Disaster Preparedness (15%). The measures were selected because they represent factors vital to life-saving emergency care. Also, the use of the federal data was critical, as these data met the key data requirements of relevance, reliability, validity, reproducibility and consistency across the states.

The use of data and guidelines from the Department of Health and Human Services and other federal agencies were important for many of the categories. For example, CDC data were particularly helpful in the Public Health and Injury Prevention Category and formed the basis for measures such as percent of children and the elderly immunized as well as for the development of disparity ratios, such as for cardiovascular disease. In addition, data from the CDC’s National Hospital Ambulatory Medical Care Survey (NHAMCS) were invaluable in portraying the critical issues facing emergency patients. CMS data was important in analyzing the number of emergency departments and the number of emergency visits to help portray the competing pressures of shrinking resources and increasing demand. Additionally, the U.S. Census data was used to develop denominators for many of the metrics.

It’s important to note that the Report Card is not a study on individual hospitals or physicians, but rather a study of how well the emergency care system is currently being supported through policies, regulations and governmental activities.

Emergency departments play a critical role within the American health care system, delivering life and limb saving care daily to thousands of patients. The moment when you, as a patient, need acute lifesaving interventions is not the time to evaluate the support for the emergency care system. If the emergency department down the street has closed because of a lack of trained physicians, or there are no hand or neurosurgeons on call because of medical liability concerns, your emergency care may be delayed.

Projected increasing demand, as well as flat or decreasing resources, are straining a system already “at the breaking point” (according to the Institute of Medicine). The increased demand is multi-factorial, including the referral by physicians of patients with acute medical needs, the utilization of the emergency department as a primary source of evaluation and stabilization of patients requiring hospitalization and the source for health care by recently insured individuals who are unable to obtain timely medical care elsewhere because of primary care shortages and/or the unpopularity of Medicaid among physicians.

ACEP’s 2014 Report Card highlights the critical need for policymakers and the public to take seriously the vital role of emergency care within the U.S. health care system. The multitude of federal data sources has helped the American College of Emergency Physicians to develop this assessment of the current environment supporting — or not supporting — emergency care.

This state-by-state Report Card is the result of a comprehensive, focused study of the emergency care environment in the United States using data from the federal government and other sources. It demonstrates how data help drive health policy at the state and national levels. Following the 2009 Report Card, state responses included passage of a motorcycle helmet law, passage of medical liability reform, funding for a statewide trauma system and establishment of new emergency medicine residency programs.

Emergency physicians and other health care providers are proud to be there to serve you, but the system urgently needs help. The reality is, access to emergency care is an unfunded federal mandate under the Emergency Medical Treatment and Labor Act (EMTALA). It is time to support the emergency care system.

See the Report Card at

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