MMS Study Puts $1.4 Billion Price Tag on Defensive Medicine in Massachusetts

As Massachusetts continues trying to keep up with the rising cost of its widely acclaimed health care reform program, a first-of-its-kind study by the MMS reveals that most of the state’s doctors practice defensive medicine for fear of malpractice lawsuits — at a cost to the state’s health care system of more than $1.4 billion a year.

&This survey clearly shows that the fear of… being sued is driving physicians to defensive medicine and dramatically increasing health care costs,” said Manish K. Sethi, M.D., one of the study’s lead researchers and a member of the MMS Board of Trustees and its Committee on Professional Liability. “This poses a critical issue, as soaring costs are the biggest threat to the success of Massachusetts health reform efforts.

The “Investigation of Defensive Medicine in Massachusetts” is the first survey to directly link defensive-medicine practices with Medicare cost data. The survey is also believed to be one of the largest of its kind, with nearly 900 physicians in eight specialties (anesthesiology, emergency medicine, family medicine, internal medicine, general surgery, neurosurgery, orthopedics, and obstetrics/gynecology) taking part between November 2007 and April 2008.

Surveyed doctors were asked about their use of seven tests and procedures — plain film X-rays, CT scans, MRIs, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions. The results showed that 83 percent of those surveyed practiced defensive medicine — and that an average of 18 to 28 percent of all tests, procedures, referrals, and consultations were ordered for defensive reasons. Thirteen (13) percent of hospitalizations also resulted from defensive practices, the survey showed.

Nationwide, the study noted, “Some estimates report that the practice of defensive medicine costs the American health care system in excess of $100 billion annually.”

Doctors Mistrust Liability System

“Physicians practice defensive medicine because they don’t trust the medical liability system,” said Alan Woodward, M.D., vice chair of the MMS Committee on Professional Liability and a past MMS president. “This survey should provide a strong impetus for fundamental liability reform. Reducing defensive medicine in Massachusetts could dramatically reduce costs and at the same time improve patient safety, access to care, and quality of care.”

President-Elect Barack Obama and others who support health care reform nationally have said much the same thing and have offered proposals to revamp the professional liability system as part of their overall reform agendas (see related story).

Dr. Sethi and his fellow researcher, Robert H. Aseltine Jr., Ph.D., of the Institute for Public Health Research at the University of Connecticut Health Center, said they believe the actual cost of defensive medicine is “significantly higher” than their survey quantified. That’s largely because the survey did not include tests and diagnostic procedures ordered by physicians in other specialties or ask about certain other defensive medicine practices, such as ordering unnecessary prescriptions.

Beyond Cost to Access

In addition to the most obvious and costly practices already mentioned, a more subtle form of defensive medicine — physicians avoiding high-risk procedures and/or high-risk patients — results in reduced patient access to care.

The MMS survey found that 38 percent of participating physicians reported they reduced the number of high-risk services they performed, with orthopedic surgeons (55 percent), obstetricians/gynecologists (54 percent), and general surgeons (48 percent) reporting the highest frequency of this. “Because of the malpractice environment, many specialists have closed their practices, stopped performing high-risk procedures, or reduced their care of high-risk patients,” Dr. Woodward said. “As a result, many smaller communities have little or no access to medical specialists.”

Dr. Woodward added that patient safety issues also arise because of defensive medicine. These include the risk of medically unnecessary radiation exposure and possible severe allergic reactions to contrast dyes used in diagnostic imaging. Also, the number of Caesarean births and the attendant risk of surgery-related complications have increased as a result of liability concerns.

Download and read the full report. (.pdf, 19 pages, 830 kb)

–Tom Walsh