Texas Drops in American College of Emergency Physicians Rankings

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.

According to a release, the state received failing grades, ranking near the bottom of the nation, in three out of five categories.

Texas ranked 47th in the nation in the Access to Emergency Care category, receiving an F. According to the Report Card, the state has severe financial barriers to medical care, high rates of people who are under-insured and low Medicaid fee levels for office visits to physicians. The closure of two hospitals in 2011 reduced staffed inpatient beds by approximately 8 percent. To improve this grade, the Report Card recommends that Texas provide adequate health insurance for both adults and children and increase Medicaid fee levels so they are at least on par with the national average.

"Texas' failing grade in Access to Emergency Care is unacceptable," said Richard Robinson, president of the Texas College of Emergency Physicians. "Texas is home to some of the finest medical centers and most notable healthcare providers in the world however many of our citizens have few to no resources (health insurance, disposable income, etc) available to access those healthcare systems and professionals under the current model. Ironically the current environment in Texas seems to prove that the best medical centers and healthcare professionals in the world cannot help you if you are unable to access them in a timely manner."

The two best grades Texas earned were a C for Disaster Preparedness and an A for Medical Liability Environment.

The Disaster Preparedness grade and 21st place ranking are improvements over the state's D+ and 41st place ranking in 2009. The state has instituted state or regional strike teams and begun enrolling health care professional in the Emergency System for Advance Registration of Volunteer Health Professionals and has the second highest rate of registered nurses who have receiving training in emergency preparedness. Texas could further improve this grade by increasing its federal disaster preparedness funding, which is still quite low.

Texas remains second in the nation for its Medical Liability Environment, which is credited with attracting large numbers of emergency physicians and specialists to the state. Texas has a $250,000 medical liability cap on non-economic damages and enacted additional liability protections for federally-mandated care delivered in emergency departments.

The second failing grade for Texas was for Quality and Patient Safety Environment, for which it was ranked 42nd in the nation. This is a significant drop from the 2009 grade of B- and 17th place ranking. The state lacks funding for quality improvements in the emergency medical services system and for a state EMS director. Texas' large size creates geographical challenges for EMS; nevertheless, to improve its grade, Texas should set statewide practices and policies to set a standard of safe and effective care for emergency response, such as field trauma triage protocols and destination policies for stroke, heart and trauma patients.

Texas, ranked 49th in the nation in Public Health and Injury Prevention, receiving a third F because of extremely high rates of obesity and cyclist and pedestrian fatalities. In addition, the state has the third highest rate of traffic fatalities related to alcohol in the country. To improve this grade, Texas must address racial and ethnic health disparities and do more to reduce obesity and improve traffic safety.

"Emergency physicians typically interact with patients experiencing an acute medical or surgical event. Many of these interactions are secondary to the failure of patients to receive health maintenance services for chronic conditions in time to prevent acute exacerbations thereby leading to emergency department visits. Improving access to health maintenance services through investment in injury prevention and public health can positively affect the lives of hundreds of thousands of Texans" said Robinson. "Texas should enact more effective traffic safety legislation and promote overall healthy lifestyles while developing methods to improve access to healthcare for its citizens."

"America's Emergency Care Environment: A State-by-State Report Card 2014" evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories: access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent). While America earned an overall mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+.

ACEP is a medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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