Nav: Home

Spending more on patients lowers doctors' malpractice risk, study finds

November 04, 2015

Physicians who spend more money and resources conducting tests and procedures for patients are less likely to be sued for malpractice, according to a new study that indicates "defensive medicine" may work.

Published Wednesday, Nov. 4 by BMJ, the study by researchers at USC, Harvard University and Stanford University noted that doctors in surveys worldwide said they practice defensive medicine - doing more for patients because they believe it reduces liability risk. The study affirms this widely-held assumption, tying higher spending to lower malpractice claim rates through an analysis of Florida physician and claims data.

Researchers also gave special attention to Caesarean deliveries due to ongoing concerns that many C-sections are performed predominantly due to physicians' malpractice concerns. The link was obvious here, too: The more C-sections that an obstetrician performed, the less likely he or she was to face malpractice complaints.

The findings raise concerns that malpractice risk could be an impediment to health care reform.

"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," said Seth Seabury, an author on the study from the USC Schaeffer Center for Health Policy and Economics.

Legislators and federal officials have tried to remove financial incentives for physicians and hospitals to provide excessive treatment through payment reform.

"One of the reasons we are moving away from the fee-for-service model is to remove the incentives of physicians to spend more. But if spending continues to shield physicians from liability risk then that incentive will still be there," said Seabury, who also is an associate professor of research at the USC School of Pharmacy and at the Keck School of Medicine of USC's Department of Emergency Medicine.

A doctor's effort can influence the outcome of a malpractice lawsuit.

"Higher spending may signal to patients, judges and juries that despite an error, the doctor did everything possible to help," said Dr. Anupam Jena, the study's lead author who is a Harvard Medical School associate professor in the Department of Health Care Policy.

Study details

The researchers obtained data from the Florida Agency for Health Care Administration and from the Florida Office of Insurance Regulation for the years 2000 to 2009. The databases included 24,637 physicians with a role in an estimated 19 million hospital discharges and 4,342 malpractice claims.

The researchers analyzed the doctors' malpractice and adjusted hospital spending rates in "physician years" - the course of a year in which any given physician appeared in the data. Researchers found an inverse correlation: As adjusted hospital spending per physician year increased, the malpractice rate dropped.

In internal medicine, for example, the malpractice claim rate per physician year was 1.5 percent, when spending was $19,725 per hospitalization. The claim rate was even lower - 0.3 percent - when spending reached $39,379 per hospitalization.

In obstetrics and gynecology, malpractice claim rates were significantly lower when C-section deliveries were high. The malpractice claim rate fell from 5.7 percent to 2.7 percent when the average adjusted C-section rate per obstetrician year rose from 5.1 percent of all deliveries to 31.6 percent.

Unanswered questions

The researchers acknowledged some limitations that raised questions worth further study:
  • The data didn't reveal physician motivation or proclivity. Perhaps some doctors were especially precautious to reduce errors in patient care. In those cases, spending might not have been wasteful.

  • The data couldn't distinguish between whether the increased spending was associated with better outcomes or simply reduced the likelihood of a malpractice claim for a given outcome.

  • The study utilized only inpatient data; however, half of all paid malpractice claims are for inpatient incidents.

  • The physician of record might not have been responsible for total spending on a patient.

  • The study did not account for situations in which a doctor might avoid treating a patient because he or she represents a high liability risk.

  • The data were from a single state, Florida, whose health care and malpractice systems may differ from other states'.

Possible solutions

Prior studies have suggested that malpractice claims are often filed due to issues with the physician-patient relationship. Malpractice claims also are often based on a doctor's failure to do something that should have been done (an error of omission), or doing something that shouldn't have been done (an error of commission).

"We need reforms that disentangle malpractice risk from spending, so that physicians who practice safe and effective medicine don't feel the need to spend more for defensive purposes," Jena noted.
The study's co-authors were Lena Schoemaker and Jay Bhattacharya, both of the Stanford University School of Medicine. The study was funded by an Early Independence Award 1DP50D017897-01 from the National Institutes of Health, awarded to Jena.

University of Southern California

Related Health Care Articles:

Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
In the January Health Affairs: Brazil's primary health care expansion
The January issue of Health Affairs includes a study that explores a much-discussed issue in global health: the role of governance in improving health, which is widely recognized as necessary but is difficult to tie to actual outcomes.
Advocacy and community health care models complement research and clinical care
Global lung cancer researchers and patient advocates today emphasized that new models of delivering care and communicating about cancer care play an important role in the fight against lung cancer.
About 1 million Texans gained health care coverage due to Affordable Care Act
Texas has experienced a roughly 6 percentage-point increase in health insurance coverage from the Affordable Care Act, according to new research by experts at Rice University and the Episcopal Health Foundation.
In India, training informal health-care providers improved quality of care
Training informal health-care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports.
Affordable Care Act has improved access to health care, but disparities persist
The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist.
Integrated team-based care shows potential for improving health care quality, use and costs
Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the Aug.
Study finds quality of care in VA health care system compares well to other settings
The quality of health care provided to US military veterans in Veterans Affairs (VA) facilities compares favorably with the treatment and services delivered outside the VA.

Related Health Care Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#520 A Closer Look at Objectivism
This week we broach the topic of Objectivism. We'll be speaking with Keith Lockitch, senior fellow at the Ayn Rand Institute, about the philosophy of Objectivism as it's taught through Ayn Rand's writings. Then we'll speak with Denise Cummins, cognitive scientist, author and fellow at the Association for Psychological Science, about the impact of Objectivist ideology on society. Related links: This is what happens when you take Ayn Rand seriously Another Critic Who Doesn’t Care What Rand Thought or Why She Thought It, Only That She’s Wrong Quote is from "A Companion to Ayn Rand"