California has received an “F” grade for “access to emergency care,” ranking 42nd in the nation, according to the 2014 American College of Emergency Physicians’ state-by- state report card on America’s emergency care environment.
The “access to emergency care” mark reflects the serious lack of on-call specialists who provide critical, specialized care like obstetricians and gynecologists, neurologists and cardiologists; a below-average number of trauma centers; a lack of inpatient hospital beds; inadequate psychiatric services; serious emergency room overcrowding and patient boarding; and the lowest number of emergency rooms per person in the nation.
Low Medi-Cal reimbursement rates also place a strain on California’s health care system, according ot the report. Repeated cuts to Medi-Cal reimbursement result in fewer physicians accepting Medi-Cal patients, causing inadequate access to primary care for Medi-Cal recipients.
According to research published in the Journal of the American Medical Association, Medi-Cal patients were most likely to be in the ER for serious conditions that might have been prevented from progressing had they had better access to primary care.
“We’re not surprised California is failing in ‘access to care’,” said Dr. Thomas Sugarman, president of the California Chapter of the American College of Emergency Physicians.
“The fact of the matter is that when you repeatedly slash Medi-Cal reimbursement, physicians won’t participate in the program, and patients are left with nowhere to go but the ER where we see everyone regardless of their insurance status,” said Sugarman. “This report card shows that Californians are paying for past budget cuts with their health.”
Another factor affecting California’s failing grade for access to care is the number of inpatient psychiatric beds.
According to the report card, California only has 18 psychiatric beds per 100,000 residents, while the national average is 29 beds and even Mississippi has 52 psychiatric beds per 100,000 people.
Without sufficient psychiatric resources in the community, psychiatric patients are taken to emergency rooms, where they use a disproportionate share of resources without receiving the psychiatric care they need, based on the report.
With the huge shortage of inpatient psychiatric beds, those patients languish in the emergency room for hours, days, and in some instances weeks, awaiting transfer to a facility where they can be treated for their psychiatric condition, according to California ACEP.
Not only is this harmful to psychiatric patients, but it creates crowding in the emergency room for all other patients in need of medical treatment, California ACEP said.
The report card indicates that patients need improved access to a complete network of physicians who can provide ongoing health care and mental health care.
As California implements the Affordable Care Act, California ACEP said legislators and regulators must take action to improve access to care by continuing recent efforts to increase mental health funding and by improving Medi-Cal reimbursement rates so patients can see a physician before their conditions deteriorate and they end up in the emergency room.
While California received failing marks for access to care, it also received a C+ in “medical liability environment” on the report card.
California’s emergency physicians face high medical liability insurance premiums, approximately $39,135 on average and no additional liability protection for Emergency Medical Treatment and Labor Act-mandated emergency care.
California also may face an attack on the California Medical Injury Compensation Reform Act through a ballot initiative that would make it easier to file meritless health care lawsuits, increase health care costs and further reduce access to care.
Weakening the reform act could have a disastrous impact on the emergency care safety net. Without the protections of MICRA, physician malpractice premiums will skyrocket once again. The financial pressures on emergency physicians- who are independent contractors, not hospital employees – are immense, according to California ACEP.
“Higher malpractice premiums translates to fewer dollars for direct patient care – fewer emergency physicians per shift, and longer wait times for all patients who walk into an ER to get care,” noted Dr. Sugarman, “Without MICRA, increased insurance premium costs for emergency physicians threaten the emergency care safety net for all of California’s patients.”
California ACEP has long argued that California’s emergency room crisis can’t be ignored.
The group said that if everyone assumes these problems will take care of themselves, that there will always be an open emergency room when they need one, “the safety net will continue to unravel to the point where the nearest emergency room might be an hour away instead of five minutes – and that will be the difference between life and death.”
California ACEP is a not-for-profit association representing California’s emergency physicians, who see and treat all Californians regardless of their ability to pay, providing more than 11 million emergency care visits each year.