Missouri gets generally good marks for disaster preparedness and access to emergency care, but it falls way short in addressing public health needs and medical liability issues. That's according to study by the American College of Emergency Physicians.
The group gave Missouri an overall grade of C- on its health care report card, ranking it 22nd among all states. Illinois ranked 45th with a grade of D.
The report says Missouri has worked to improve an already strong disaster preparedness program by adding a patient-tracking system and dialysis patients to its medical response plan. The state has been working on these additional programs at least since 2011. But Missouri had one of the lowest investment rates in prevention programs. The amount comes to $13.36 for every 1,000 persons, according to ACEP.
The relatively low investment is probably “reflected in higher-than-average preventable death rates in several areas,” including homicides, suicides and traffic fatalities, the report says.
Missouri got a C+ grade for providing access to emergency care. Missouri isn't ranked higher because of financial barriers to care and a shortage of primary care providers. The report urges the state to do more to enable its low-income and youth populations to have access to better health care.
Changes are coming thanks to the Affordable Care Act
Emergency care doctors in the state don’t dispute the findings. While pointing to some improvements, the physicians say the medical system is about to face a big challenge as newly insured patients enter the health pipeline through the Affordable Care Act.
“One of the biggest issues with the ACA, as more people will be insured, is whether there will be primary care doctors to see them,” says Rob Poirier, clinical chief of emergency medicine and an assistant professor at Washington University School of Medicine.
“Physicians already have very full schedules and are overbooked. The result is when people call their doctor’s office, they are being told there will be no appointments for the next couple of weeks,” Poirier says.
Efforts are being made to address shortages of primary care doctors, he says. These include increasing the size of medical school classes and the number of residency spots available for training physicians.
“We are also looking at using nurse practitioners and physician assistants to work with physicians so physicians can schedule more patients,” Poirier says.
Dr. Larry Slaughter, head of the Missouri chapter of ACEP, says one challenge to improving the states emergency care is that not enough doctors are choosing to practice primary care medicine. He says it’s understandable that many of his colleagues choose specialty care because they leave medical school with huge student loan debt. Medical specialties pay far more than primary care, so it's only logical that new doctors chose to specialize. He says doctors reason that, “if I can pay back this loan quicker, I can pay for college education for my kid and other things in life.”
Slaughter says that shortages of all types of physicians in rural parts of Missouri are “very frustrating since Missouri hasn’t expanded Medicaid,” to serve more of the poor uninsured. But, like Poirier, he says Missouri lacks enough primary care doctors to treat all the newly insured patients under ACA.
Another concern of both physicians and those issuing the report is Missouri’s elimination of a medical liability cap on non-economic damages. Slaughter says removing the cap means higher insurance rates for doctors.
“The state legislature is looking at that, and it’s certainly a very big issue to us,” he says.
Public health policies have an impact, too
On the public health front, both doctors also say Missouri needs to do more to address risky behavior that can lead to otherwise preventable diseases and injuries. They point to more vigorous enforcement of child safety belt and seatbelt laws to reduce traffic fatalities, and stricter legislation for smoke-free environments across the board.
An example of the impact that some public health policies can have on emergency care is a motorcycle helmet law. Missouri has a law, and it helps reduce injuries, Poirier says. But, Illinois lacks a law, “so we treat lots of cases of head injuries from residents who live in Illinois.”
Overall, Poirier says, Missouri’s health system is “pretty good” in terms of specialty care, psychiatric care beds and trauma centers and emergency departments. Still, he says, "even though there are things in this report that we can be very proud of, we definitely still have a lot of work to do. Nobody is happy with a grade of C-.”