Study: More Doctor Spending Linked to Fewer Malpractice Risks

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By David McAfee

Nov. 6 — Medical doctors who spend more time, money and resources on patient tests and procedures are generally less likely to be sued for malpractice, according to a study published Nov. 4 by the British Medical Journal (BMJ).

The study, which was conducted by researchers at the University of Southern California, Harvard Medical School and Stanford University, found that “defensive medicine” may work to reduce the chances of a medical malpractice claim. Defensive medicine, according to the study’s authors, means “doing more for patients because they believe it reduces liability risk.”

Seth Seabury, an author on the study from the USC Schaeffer Center for Health Policy and Economics, said the lower risk of malpractice liability could undermine health-care reforms.

“More and more we are relying on physicians to help eliminate wasteful spending in health care. However, if physicians perceive that lowering spending will subject them to greater malpractice risk, it will be that much harder to move the needle on health care spending,” Seabury wrote in a Nov. 4 statement, adding that legislators are trying to remove financial incentives for doctors to spend more.

“But if spending continues to shield physicians from liability risk then that incentive will still be there,” he said.

The study, which analyzed data from Florida hospitals and malpractice claims, confirms the long-suspected fact that doctors use defensive medicine and that it protects them from liability. Before this analysis, according to the researchers, there were no studies showing whether increased physician spending reduced claims.

Data Collected

Researchers at USC, Harvard and Stanford collected data in connection with 24,637 physicians, 154,725 physician years and 18,352,391 hospital admissions. They also looked at information related to 4,342 malpractice claims made against the physicians, according to the study’s abstract.

“Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim,” the authors wrote. “For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% in the bottom spending fifth to 0.3% in the top fifth.”

The researchers looked at information from admissions to Florida acute care hospitals between 2000 and 2009 and focused on obstetrics, where they say the choice of caesarean deliveries is “suggested to be influenced by defensive medicine.”

Health Experts Weigh In

Some health experts say the study raises more questions than it answers.

Tomas J. Philipson, who serves as the Daniel Levin Professor of Public Policy Studies at The University of Chicago and as a health-care director at the Becker Friedman Institute, said the study “has raised important questions about the costs and benefits of the medical malpractice system.”

“On the one hand it makes doctors spend more to avoid liability but, since liability comes from bad health outcomes, this must be weighed against the improvements in patient health this spending enables,” Philipson, who focuses on health economics research, told Bloomberg BNA in a Nov. 6 e-mail. “The real question is how productive this additional spending is in terms of improving patient outcomes.”

Other professionals in the health-care field say the study found exactly what already was predicted about the current health system: that defensive medicine has become necessary despite being potentially harmful in the long run.

Dennis Hursh, managing partner of Pennsylvania physician’s law firm Hursh & Hursh PC, says the study validates what he has been hearing from his physician clients for almost 30 years—that “defensive medicine is absolutely required to protect physicians from an out of control judicial system.”

“I have never met a physician who didn’t want to practice safe and effective medicine. I have, however, spoken to literally dozens of physicians who feel forced to order tests and procedures that they know will most likely be of marginal value to the patient,” Hursh, a member of the American Health Lawyers Association, told Bloomberg BNA Nov. 6. “They believe that failing to do so is an invitation to a malpractice suit.”

Hursh further noted that “defensive medicine” isn’t just expensive–it can also be risky for the patient.

“Many physicians would gladly forgo testing and procedures that they feel are unlikely to benefit the patient if they didn’t have the threat of a lawsuit facing them for every clinical decision they make,” Hursh added. “We will never be able to truly control costs until we give our physicians the freedom to use their best clinical judgment in treating patients, without the fear of being second-guessed by lawyers and judges.”

John R. Patrick, author of Health Attitude: Unraveling and Solving the Complexities of Healthcare, says it’s “no surprise” to find a study confirming that more tests and procedures lead to lower malpractice risk.

“This is a logical conclusion, but it does not mean it is a good thing,” Patrick, who holds a doctorate in health-care administration, told Bloomberg BNA in a Nov. 6 interview. “It is a bad thing because it drives up the cost of health care. With 10,000 people turning 65 every day and joining Medicare, we cannot afford the current spending per person.”

Patrick added that studies show the cost of unnecessary tests and procedures reaching up to $1.5 trillion.

“It will bankrupt the country if we don't reduce our health-care spending,” Patrick said.

To contact the reporter on this story: David McAfee in Los Angeles at dmcafee@bna.com

To contact the editor responsible for this story: Nancy Simmons at nsimmons@bna.com

The study is at http://src.bna.com/X5.