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By Martin Ogle, MD, FACEP

On Jan. 16, 2014, ACEP released the latest version of its National Report Card on the State of Emergency Medicine. The report rates both the nation and individual states in five areas:

  • Access to Emergency Care
  • Quality & Patient Safety Environment
  • Medical Liability Environment
  • Public Health & Injury Prevention
  • Disaster Preparedness

  • In its last report released in 2009, ACEP gave the nation an overall grade of C-. In 2014, we earned a D+.

    Both reports identified Access to Emergency Care as the area of greatest need. (In fact, the nation earned a D- in this area in both 2009 and 2014.) The access grade evaluates:

  • Availability of providers
  • Availability of treatment centers
  • Financial barriers
  • Hospital capacity

  • Access is the highest-weighted of the five categories, accounting for 40 percent of the overall grade.

    So is it true that we've made virtually no progress at improving the average person’s access to emergency care? As someone involved in healthcare advocacy, I'd have to agree that we haven't made a whole lot of progress. I do feel we've done a good job defining some real quantitative measures of access. But there's been relatively little political, regulatory or legislative movement to use these measures to guide policy.

    1/27/2014 10:51:55 PM | 1 comments

    Myles Riner, MD, FACEP

    The nice folks at Perspectives on the Acute Care Continuum asked The Fickle Finger to take another shot at gazing into the crystal ball of healthcare trends and events for 2014. Looking back at last year's effort, I think these predictions were reasonably accurate, except perhaps for this one: Obama will use his Constitutional authority to raise the debt ceiling without Congressional approval. Never happened, because Republicans in Congress eventually chickened out.

    I think my predictions specific to emergency medicine (EM) were nearly spot-on:

    1. There will be more emergency department (ED) visits in 2013 than in prior years.
    2. Emergency physicians will make less money in 2013 than in prior years.
    3. More ED patients (and sicker ones) will be treated by nurse practitioners (NPs) in the ED.
    4. Commercial and government payers will push back on emergency physicians (EPs) even harder in 2013 through RAC and commercial claims audits and recoupment demands.
    5. Single ED groups will continue to be swallowed up by hospitals and larger ED groups.
    6. The popularity of EM residencies, relative to other specialty training programs, will begin to peak in 2013.
    7. ED boarding of admitted patients will continue to plague the practice of EM.

    Not surprisingly, most politicians won't give a damn.

    I can't prove #2, but I still think it is true, in part because EPs are working fewer hours per month, but EP incomes may have been (temporarily) sustained by significantly rising charges throughout the industry.

    In any case, here is The Fickle Finger's set of predictions for 2014. I am trying not to be too pessimistic, but this last year was dismal, except for the stock market; and this year will likely be just as bad, except for the stock market.

    1/2/2014 5:58:57 PM | 0 comments