In the first, known prospective study, Pennsylvania orthopedic surgeons admitted that almost 20% of the imaging studies they ordered were for defensive purposes.
All of the previous data that hinted at the rampant practice of defensive medicine relied on surveys or other forms of retrospective data.
In this study,
A total of 72 orthopedic surgeons agreed to participate, submitting information on a total of 2,068 scans.
Of these, 396 — 19.1% — were listed as primarily defensive.
About 70% of these were conventional x-rays and 25% were MRI scans.
But the MRI scans accounted for about 75% of the defensive costs, Miller and colleagues estimated using Medicare reimbursement rates.
As regular readers of KevinMD.com know, defensive medicine is controversial. Physicians swear that most doctors practice it. Plaintiff attorneys question that, and argue whether states that have enacted tort reform impact defensive medicine rates.
I’ve written previously that the costs incurred by defensive medicine are probably overstated. A study in Health Affairs last year pegs the number at $56 billion, or 2.4% of the nation’s total health costs, while the CBO estimated last year that tort reform, in guise of malpractice caps, would save about $55.6 billion, mostly by curbing defensive medicine.
Although saving tens of billions of dollars shouldn’t be discounted by health policy experts, I continue to urge tort reform supporters to stop using costs as a reason to enact malpractice reform. The numbers aren’t there yet. Instead, approach it from the patient point of view, and emphasize that the current system does injured patients a disservice. The data supporting that is significantly stronger, and the argument more compelling to patients and political decision makers.
Back to the study, which was conducted in Pennsylvania, traditionally viewed as a malpractice-unfriendly state to practice medicine. Repeating the same study in a state that has enacted tort reform, like Texas, would be helpful. That way, we can determine whether tort reform has any impact on defensive medicine rates, and perhaps, contribute more evidence supporting physicians’ point of view.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, and LinkedIn.
