Texas emergency medical services earned a D+ grade, falling in the past five years from 29th to 38th place nationwide, according to a report by the American College of Emergency Physicians.
Texas failed in providing access to emergency care, quality and patient safety and public health and injury prevention based on 136 measures, according to the report card issued last week.
And things will become worse in Texas and nationwide as more Americans become insured under the Affordable Care Act, yet have little access to preventive care because there aren’t enough doctors to meet the demand, said Dr. Alex Rosenau, president of the American College for Emergency Physicians.
“This report card is sending an alarm,” Rosenau said. “The need for emergency care is increasing. We are failing to support our emergency patients.”
Dr. Arlo Weltge, a Texas Medical Center emergency department doctor, echoed that view, saying the report shows Texans don’t have doctors who could help keep them healthy.
“What we are missing in Texas is a functioning primary care system,” said Weltge, who also is a clinical professor of emergency medicine and member of the American College of Emergency Physicians. “Right now, today, we’re in the middle of a serious flu season. We’re seeing some incredibly ill patients. Most institutions are overwhelmed with patients, which could have been avoided if they had received early treatment and vaccinations.”
The organization’s report evaluates how emergency care is delivered state by state. It includes 136 measures in five categories: access to emergency care, quality and patient safety, medical liability, public health and injury prevention and disaster preparedness.
No state got an overall A. Wyoming was the only state to score an overall F.
Texas’ D+ reflected the nation’s grade as a whole. However, it scored well or average in two categories, getting an A in medical liability, which limits how much money people can seek in damages, and a C for disaster preparedness.
The study does not evaluate or compare the care at individual hospitals. It also does not break down scores by region or city.
Medicaid a factor
State and local health care providers and experts agreed with the report’s assessment that Texas’ high rate of uninsured residents and low Medicaid reimbursements prevent people from getting regular treatments and vaccines that would keep them out of emergency rooms. An estimated 6 million Texans, about 25 percent of the state’s population, are uninsured.
State leaders, who oppose the Affordable Care Act, did not expand Medicaid to cover more lower-income residents under the Affordable Care Act. About 1 million residents will remain uninsured and use emergency rooms, said Lance Lunsford, spokesman for the Texas Hospital Association.
“That’s going to have a significant effect as that population continues requiring care and will likely not seek it in the primary care setting,” he said.
Patricia Gray, the University of Houston’s Health Law and Policy Institute’s research director, said the state’s Medicaid policy isn’t likely to change soon. She said newly insured residents also won’t stop seeking emergency care until they learn how to use their coverage.
“They’re not used to doing anything else,” she said.“We’re never going to do away with emergency rooms or disease outbreaks. The more we can do to educate people to become healthy to stay out of emergency rooms, the more this problem will settle itself.”
Gray said Texas’ failing grade in public health and injury prevention indicates the state isn’t doing enough to teach people about disease prevention. Yet, it was troubling Texas was rewarded for having a $250,000 medical liability cap, she said.
“We’re so focused on limiting liability and less focused on how to teach people to take care of themselves,” Gray said, adding that more health education could lead to less treatments and concern about medical liability.
Besides failing in emergency care access and public health, Texas also received an F in quality and patient safety as a result of the state’s failure to fund improvements to its emergency medical system and establish coordinated triage and transportation policies for heart attack victims. Gray said hospitals statewide have begun to achieve specialty designations in stroke and heart attack care, which will lead to improved policies to get patients to those facilities.
“We are still behind on things that should be seen as really basic,” she said.“Texas is very slow to move. It’s a really big state.”
Texas’ rank challenged
While he said he appreciated the report’s “red flags,” Dr. Jeff Kalina, Houston Methodist Hospital’s emergency services director, took issue with Texas’ near-failing ranking. He said it was disingenuous for it to appear as if all hospitals in all regions of the state were under-performing.
“I don’t think the reality matches the scorecard,” he said. “It all depends on the criteria they’re using.”
He and Lunsford especially questioned the report’s average rating for Texas’ disaster preparedness. Within the last dozen years, the state has been hit by several damaging hurricanes, plus last year’s devastating explosion in West.
“We had hundreds and hundreds of patients who required care,” Kalina said of the Texas Medical Center’s hurricane responses. “We’ve had real-life responses to disasters. We’ve done an incredible job. Sometimes reality doesn’t mesh with scorecards. We have proven over and over again in disaster response we can take care of it.”
Emergency room report card Texas dropped from 29th in the nation in 2009 to 38th in the 2014 American College of Emergency Physicians’ state-by-state report card on America’s emergency care environment.