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Damage caps confer fewer invasive tests, PCI procedures
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After the adoption of damage caps, physicians were more likely to change their CAD testing practices to those that were less invasive and to perform fewer PCI procedures, according to a study published in JAMA Cardiology.
“These findings suggest that physicians are willing to tolerate greater clinical uncertainty in CAD testing and treatment if they face lower malpractice risk,” Steven A. Farmer, MD, PhD, FACC, FASE, associate professor of medicine and public health at George Washington University and associate director of the GW Center for Healthcare Innovation and Policy Research in Washington, D.C., and colleagues wrote.
Researchers utilized a difference-in-differences design to analyze 36,647 physicians from nine states that from 2003 to 2005 adopted caps on the amount of damages physicians could be liable for and 39,154 physicians from 20 no-cap states. Physicians included in the sample ordered or performed two or more angiographies during the study. The patient population was derived from a 5% random sample of Medicare fee-for-service beneficiaries from 1999 to 2013.
New-cap states had more minorities, younger populations, fewer physicians per capita, lower per-capita incomes and lower managed care penetration compared with no-cap states, according to the researchers.
Compared with control physicians, new-cap physicians reduced their use of invasive testing as a first diagnostic test after cap adoption (–23.9%; 95% CI, –40.11 to –7.7). There was also a numerical increase in noninvasive stress testing in these physicians (7.84%; 95% CI, –3.61 to 19.28) and a significant decrease in angiography referrals after stress testing (–20.95%; 95% CI, –40.08 to –1.81).
Revascularization rates after ischemic evaluation also decreased among new-cap physicians (–22.92%; 95% CI, –40.05 to –3.8), driven by fewer PCI procedures. New-cap and control physicians had similar changes in overall ischemic evaluation rates (–0.05%; 95% CI, –8.01 to 7.9).
“Curtailing marginal or unnecessary angiography and revascularization spares patients invasive procedures and associated risk and saves resources,” Farmer and colleagues wrote. “In addition, both the Department of Health and Human Services and commercial payers are moving rapidly toward alternate payment models. A core issue for these models is provider resistance to changing established practice patterns. Our study suggests that physicians who face lower malpractice risk may be less concerned with that risk, and thus more receptive to new care delivery strategies associated with alternate payment models.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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