It’s only logical to think that there would be a connection between the number of medical tests a doctor ordered for his/her patients and how often he or she is sued for malpractice, but there had been virtually no empirical proof of this assumption until now.

A new study published November 4th in the journal BMJ by researchers at USC, Harvard University and Stanford University confirms this widely-held assumption, tying higher spending on patients to lower malpractice claim rates based on an analysis of Florida physician and claims data.

Defensive Medicine

Statement from study author Seth Seabury

The results of the study raise concerns that the decision by a growing number of doctors to practice defensive medicine due to malpractice risk is a potential 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,” noted Seth Seabury, an author on the study from the USC Schaeffer Center for Health Policy and Economics.

The government has been working to remove financial incentives for physicians and hospitals to provide unnecessary treatment by reforming the payment system.

“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,” Seabury, who is an associate professor of research at the USC School of Pharmacy and at the Keck School of Medicine in Emergency Medicine, explained.

Details on new “defensive medicine” study

The research team acquired data from the Florida Agency for Health Care Administration and from the Florida Office of Insurance Regulation from 2000 to 2009. The databases included 24,637 physicians involved in an estimated 19 million hospital discharges and 4,342 malpractice claims.

The methodology of the study involved studying the doctors’ malpractice and adjusted hospital spending rates in “physician years”, ie, the course of a year in which any given physician showed up in the data set.

Of note, when they analyzed the data set, the researchers found an inverse correlation. That is, as adjusted hospital spending per physician year increased, the malpractice rate decreased.

Taking a closer look at the specialty of internal medicine, for example, where the malpractice claim rate per physician year was 1.5% when spending was $19,725 per hospitalization. However, the claim rate was notably lower at 0.3% when spending reached $39,379 per hospitalization.

Breaking down rates in obstetrics and gynecology, it can be seen that malpractice claim rates were significantly lower when C-section deliveries per doctor were high. The malpractice claim rate dropped from 5.7% to 2.7% when the average adjusted C-section rate per obstetrician year increased from 5.1% of all deliveries to 31.6%.

The researchers chose to focus on Caesarean deliveries due to concerns that many C-sections today are performed largely due to physicians’ malpractice concerns rather than medical necessity. The relationship here was also clear: The more C-sections that an obstetrician performed, the less likely she was to have malpractice complaints.

Defensive Medicine