(In 16th paragraph changes to show that American College of
Emergency Physicians corrected its list to show that Arkansas,
not Arizona, is one of the bottom-ranking states)
By Susan Heavey
WASHINGTON Jan 16 People seeking urgent medical
could face longer wait times and other challenges as demand
increases under Obamacare, U.S. emergency doctors said in a
report on Thursday that gives the nation's emergency
infrastructure a near failing grade.
In its latest "report card," the American College of
Emergency Physicians said such reduced access earned the nation
a "D+" -- that's down from the overall "C-" grade from the
group's last report in 2009.
Shortages and reduced hospital capacity make it more
difficult to access emergency care, the group said. It also
warned about the impact on disaster preparedness.
While the report does not measure the actual quality of care
provided, it does offer a snapshot of national and state
policies affecting emergency medicine as seen by providers.
Washington, D.C., was ranked the highest in the report,
earning a "B-" grade, while Wyoming ranked last and was the only
state to earn an overall failing grade of "F."
The group's task force looked at scores of measure in five
major categories -- access to care, quality and patient safety,
liability, injury prevention and disaster preparedness -- and
relied on data from the Centers for Disease Control and the
Centers for Medicare and Medicaid Services, among others.
The report comes just as the Affordable Care Act, known as
Obamacare, comes into full effect this year. The 2010 law aims
to expand access to health insurance and reduce the nation's
healthcare costs, but it has become a political flashpoint amid
a troubled rollout of the federal insurance exchange website.
While the physician's report does not factor in all of the
effects of the law -- its grades are based on data from early
2013 -- emergency rooms could be used even more as more
Americans gain insurance coverage under Obamacare, it said.
Some health experts have predicted that increasing the
number of insured patients should reduce pressure on hospital
emergency rooms because access to regular doctor care will
improve, something that is hoped would prevent chronic
conditions from spiraling out of control or help catch other
problems before they worsen.
But insurance coverage could also lead those who might have
held off going to the emergency room to seek care, said Jon Mark
Hirshon, an emergency medicine doctor and researcher at the
University of Maryland who oversaw the group's report card.
Newly insured people also may have a hard time finding a
regular doctor who accepts their plan, he said.
"On top of that, emergency departments are open 24 hours a
day, seven days a week. If I have a primary care provider but
it's 9 o'clock at night on a Friday and they're closed, then
people come to the emergency department," Hirshon told Reuters.
The group is asking for congressional hearings to probe
whether the law puts "additional strains" on emergency rooms.
Already, beds for patients have fallen from a rate of 358
per 100,000 people four years ago to about 330 beds per 100,000
people now, the report said. Wait times have increased to a
median of 4.5 hours compared to four hours in 2009.
Despite the dismal U.S. grade given by the group, it noted
that policies and infrastructure varied widely by state.
States with the best emergency care include Massachusetts,
Maine, Nebraska and Colorado, while Kentucky, Montana, New
Mexico and Arkansas rounded out the bottom, just above Wyoming.
States are also still grappling with the uninsured. By law,
hospitals must provide emergency care regardless of patients'
ability to pay. Under Obamacare, states can expand access to
Medicaid, the federal-state health insurance plan for the poor.
Data shows that Medicaid patients use emergency rooms as
much as other insured patients, but several recent studies have
shown that Medicaid patients utilize them more than the
One study this month showed Oregon patients given Medicaid
through a lottery increased their emergency room use by 40
percent compared to those not offered Medicaid.
"We have to be leaner and more efficient, but it just
becomes more and more challenging," Hirshon said.
(Reporting by Susan Heavey; Editing by Leslie Adler)