Latest ACEP national, state-level report cards cite ample room for improvement.

In its latest round of report cards on the emergency care environment, the American College of Emergency Physicians (ACEP) gave the nation an overall ranking of D+, a slight decline from the rankings unveiled in 2009. Overall state-level rankings were also unveiled, as well as individual rankings for access, quality and safety, medical liability environment, public health and injury prevention, and disaster preparedness. Leaders at ACEP urge providers to use the rankings to advocate for change in their states; however, there is concern that the report cards are already being misinterpreted as being a reflection of care quality rather than the emergency care environment. * Notably, on the national report card, access to emergency care received an overall grade of D-, and it accounted for 30% of the overall grade. * Among the state-level rankings, Washington, DC, Massachusetts, Maine, and Nebraska were the top performers, earning an overall grade of B-. * At the other end of the spectrum, Wyoming received an overall grade of F, Arizona received a D-, and Montana, New Mexico, and Kentucky each received a grade of D.