Physicians Group Gives Poor Grade to Emergency Care in New Jersey

Andrew Kitchenman | January 17, 2014 | Health Care
Limited access due to hospital closures, malpractice rules cited in giving state a “D-Plus”

US-NJ emergency services
New Jersey’s emergency care nearly earned a grade of “F” on a report card released by a physicians group this week.

The American College of Emergency Physicians’ report card gave the state a “D-plus,” which is a full letter grade lower than the grade New Jersey received for the last ACEP report in 2009.

There is one small consolation: The state’s dismal grade is the same grade that the group gave emergency care nationwide.

However, New Jersey’s mark fell further than the nation’s grade since the report issued five years ago, when the United States received a “C-minus.”

The reasons for New Jersey’s low score were concentrated in two areas: access to emergency care and the state’s malpractice rules. ACEP officials identified the state’s hospital closures as a factor in declining access to emergency care, while the state’s long-standing relative friendliness to malpractice plaintiffs makes other states more attractive to emergency doctors.

Current ACEP New Jersey President Dr. David Adinaro said access to emergency care has gotten much worse in the state over the past give years, with the ACEP grade for access falling from “C” to “F.” He said hospital closures, the low number of emergency physicians and insurance treatment of emergency visits are among the factors that fed into the grade.

“Our system is at a tipping point in a crisis, in a way,” Adinaro said. “Continued loss of hospitals and the emergency departments that are attached to it means the emergency departments are going to get more and more full.”

He also said that it is difficult for New Jersey emergency doctors to refer uninsured and Medicaid doctors to specialists for follow-up care. He noted that the state’s Medicaid reimbursement rates, which are among the lowest in the country, lead to a lack of orthopedists, plastic surgeons, neurologists and other specialists treating these patients. Adinaro would like to see the state increase its Medicaid reimbursements.

“If physicians do not take Medicaid, it’s hard for us to get the care that patients need in follow-up,” he said. “You know, we can take care of your broken bone in the emergency department, but then you need to follow up for it.”

The state also received an “F” for its medical liability environment, the same grade it received in 2009.

Adinaro would like to see the state Legislature enact a bill reducing the legal liability for emergency doctors treating uninsured patients who they are required to treat under the 1986 Emergency Medical Treatment & Labor Act. He said passing such a bill would be a step in the right direction.

“You need to not put so many roadblocks in the way” to encourage doctors who treat these patients, Adinaro said.

Not all of New Jersey’s grades were bad. The state received a “B” for its public health and prevention environment. Adinaro said New Jersey’s strong disaster response preparations, stringent drunk-driving laws, and a ban on texting while driving are among the positives that fed into that grade.

“There are some positive things happening in New Jersey – it’s not just all in the negative,” Adinaro said.

In describing the overall environment faced by New Jersey’s emergency doctors, Adinaro said they are increasingly serving a key role in treating an aging population that will require more emergency services.

While he applauds efforts to provide care that prevents patients’ problems from developing into emergency, he also cautioned against a sole focus on reducing emergency-department visits. He expressed concern that patients facing genuine emergencies that require the expertise of emergency doctors will be diverted to primary care settings.