Virginia College of Virginia College of
Emergency Physicians
Contact: Steve Haner 804-874-0149
Gwen Harry 757-220-4911
Virginia’s Emergency Medical Care System Graded D+,
Ranked in Bottom Six in Nation
RICHMOND – The emergency medical care network in Virginia was listed in grave condition, with a grade of D plus, in a report released today by the American College of Emergency Physicians. Virginia ranked 46th in the nation.
“When we Virginians are struck with an emergency, we expect a system that is prepared to care for us safely and efficiently, to protect our life and limb, our child or parent,” said Dr. James Dudley of Tappahannock, president of the Virginia College of Emergency Physicians.
“What this report card shows is that compared with other states the system in Virginia is struggling to provide that care in a D+ environment. The evidence of that is delayed or even gridlocked care, an overstretched staff, and sometimes diversion or transfer to a distant hospital for care,” Dudley said. “Gridlock should be unacceptable to everyone.”
The report compared Virginia to all 50 states and the District of Columbia on objective measures in four major categories. Virginia was given:
In most cases the report used readily-available published data, but that means in some areas the comparisons are sometimes two to three years old. In particular, the report cited:
1) Virginia’s overall low Medicaid reimbursement rates. Virginia’s payments to doctors and other providers consistently rank among the bottom in the nation. While it isn’t specifically cited in the report, the average Medicaid payment for an emergency visit in Virginia is $45.
2) Problems with access to care, also related to finances. Hospital emergency departments (ED) have a federal mandate to screen and stabilize all patients, regardless of their ability to pay. As a result, increasing numbers of uninsured patients with nowhere else to go often wait until they are very sick and then seek help in emergency departments, adding to the crowding. A large number of people pay nothing for their care. At the same time all health insurance payors, including private insurance companies, Medicare and Medicaid are paying less for services. Under and uncompensated care means fewer resources for everyone. Emergency department personnel are hard to recruit and keep in this financial environment.
Overcrowding in the emergency department is often caused by a lack of staffed beds in the main hospital. The report cited Virginia’s low number of emergency departments per 1,000,000 residents (41st in the nation), low annual per capita expenditure on hospital care (40th) and low number of staffed hospital beds per 1,000 residents (37th).
“Often the gridlock isn’t a problem with the emergency department itself, but the inability to move patients who are ready to be admitted into regular hospital beds. But that won’t draw much sympathy from somebody in an ambulance that is sent to a second or third location,” Dr. Dudley said. He reported examples of long-distance diversions even at the rural hospital where he works.
Like the majority of states, Virginia does not gather statewide data on the diversion of patients away from the nearest emergency facility.
3) Virginia’s medical liability climate, graded F, is contributing to major increases in malpractice insurance costs for emergency physicians and the facilities where they work. Virginia physicians overall faced a staggering increase of 153 percent in their malpractice premiums during the period measured (2001-2004) and specialists saw their rates increase 142 percent. The response of some specialists has been to decline to serve “on call” for emergency cases or to leave the profession entirely.
Due to pressure by trial lawyers on the legislators, Virginia does not have a cap on non-economic damages (“pain and suffering”) and the General Assembly has routinely defeated that idea. Virginia does have an overall medical malpractice cap, for which it received partial credit in the report. The report also cited Virginia for poor controls on expert witness testimony and recommended that higher standards be imposed on potential witnesses. This issue was also addressed to some extent last year, but the progress may not be reflected on the report card.
“Some of these issues are related to money, and some relate to policy decisions made by the Virginia General Assembly. None of them is insurmountable, and we look forward to working with the 2006 General Assembly and Governor-elect Tim Kaine to address them,” said Dr. Derik King, medical director of the emergency department at Henrico Doctors’ Hospital-Forest.
“Legislation is pending in Congress to increase physician payments for hospital emergency care and to give hospitals incentives to move patients promptly into regular beds. It would be a mistake for Virginia to wait for federal action to address some of these problems,” King said. “Some can be addressed in the next two months.”
In the last couple of years Virginia has improved its Medicaid payment level and some of that improvement is probably not reflected in the report card, based on 2003 data. This year a broad coalition of health care providers, the Commonwealth Care Coalition, has recommended a 10 percent increase in reimbursements. Governor Mark Warner’s introduced budget included a three percent increase for 2007.
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Additional Background Information:
The American College of Emergency Physicians is the national medical specialty society representing emergency medicine. With more than 23,000 members, ACEP is committed to improving the quality of 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.
The Virginia College of Emergency Physicians has 550 members.
Virginia has five Level One trauma centers – at the Virginia Commonwealth University Medical Center, the University of Virginia Hospitals, Sentara Norfolk General Hospital, Inova Fairfax Hospital and Carillion Roanoke Memorial Hospital.
The full report is available at www.acep.org. A news conference on the nationwide data was held today at 10 a.m. at the National Press Club in D.C.
The participants in today’s Richmond news conference are:
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Statement of Dr. James Dudley
January 10, 2006
Good morning. Thank you for being here. My name is Dr. James Dudley, and I am the President of the Virginia College of Emergency Physicians. I practice emergency medicine at Tappahannock-Riverside Hospital in Tappahannock.
I would like to introduce the other people who are here with me at the podium.
(Introductions)
When I first heard about this project, I honestly thought Virginia would get a better score than this. I was expecting a high C, maybe even a low B. It was disappointing to have our peers grade the emergency medical care system in Virginia as one of the five or six worst in the country. But a high C wouldn’t have been a grade to brag about, either.
When we Virginians are struck with an emergency, we expect a system that is prepared to care for us safely and efficiently, to protect our life and limb, our child or parent. What this report card shows is that compared with other states the system in Virginia is struggling to provide that care in a D+ environment. The evidence of that is delayed or even gridlocked care, an overstretched staff, and sometimes diversion or transfer to a distant hospital for care.
Gridlock should be unacceptable to everyone.
It isn’t just a problem in big urban centers such as Richmond or Norfolk – in my own practice in Tappahannock I’ve often dealt with patients who were diverted from other nearby counties because there was no room at the nearest facility.
Often the gridlock isn’t a problem with the emergency department itself, but the inability to move patients who are ready to be admitted into regular hospital beds. But that won’t draw much sympathy from somebody in an ambulance that is sent to a second or third location. That won’t draw much sympathy when a local patient with an urgent but not life-threatening emergency has to wait while someone transferred from far away with a dire emergency gets treated first. Everyone understands when this happens after a major wreck or disaster, but this really is becoming a common occurrence all across Virginia.
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Statement of Dr. Derik King
January 10, 2006
Thank you for joining us. I am Derik King and I am Medical Director of the emergency department at Henrico Doctors’ Hospital.
I want to second what Dr. Dudley said, that one way or another most of the problems cited in this report deal with access to care. This is not a D+ on the quality of care; it’s a D+ on the quality of access to that care. The nurses, doctors, and technicians in our emergency departments provide excellent care. The problem is whether you can get into an ED promptly, and whether Virginia has done everything it can to keep you from needing to go in the first place.
The problems are keeping emergency departments open, retaining the doctors and nurses we have, and attracting the next generation to practice in Virginia. These problems are caused by Virginia’s extremely low payments by government and private insurance programs, the frustrations of working in a gridlocked system, and the constant threat of lawsuit hanging over the practitioners and the hospitals.
Some of these issues are related to money, and some relate to policy decisions made by the Virginia General Assembly. None of them is insurmountable or unduly expensive, and we look forward to working with the 2006 General Assembly and Governor-elect Tim Kaine to address them. We hope Virginia can show some real progress the next time the American College of Emergency Physicians publishes this report.
Legislation is pending in Congress to increase physician payments for hospital emergency care and to give hospitals incentives to move patients promptly into regular beds. But it would be a mistake for Virginia to wait for federal action to address some of these problems. Some can be addressed in the next two months.
Between now and the end of the 2006 General Assembly, we hope the legislature will
1. Improve the reimbursement payments made under Medicaid to the doctors and the hospitals;
2. Adopt some of the medical tort reform measures it has ignored in the past; and
3. Find a solution to the very real problem created when patients collect directly from their insurance carrier and then do not pay the doctor who treated them.
In closing, this report is not about the quality of emergency care in Virginia, it is about the access to and the environment in which patients enter when emergencies happen. Virginia’s system is functioning in a D+ environment, and this system needs to be strengthened. The public as well as policy makers need to be reminded that Emergency Medical care is an essential public service, and as such has a direct impact on the health and safety of everyone.
Thank you and I’ll be happy to entertain any questions.
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