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Study illustrates high cost of defensive medicine practices by orthopedists
A study by Vanderbilt University researchers estimates that U.S. orthopedic surgeons create approximately $2 billion per year in unnecessary health care costs through the practice of defensive medicine.
The research suggests that unnecessary costs associated with the practice of defensive medicine play a role in the increasing costs of health care, according to a Vanderbilt University Medical Center news release.
According to A. Alex Jahangir, MD, who presented the information at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, “$2.3 trillion of our gross domestic product [GDP] is spent on health care — 16% of our GDP … one out of every five dollars this country spends goes to health care, which prevents it from being spent on education or infrastructure. Furthermore, health care costs are the number one cause of bankruptcy in the United States.”
“Part of this conversation, and one thing that I think really has not been discussed, is the impact defensive medicine has on health care spending,” he said.
Online survey
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For their study, Jahangir and colleagues sent an online survey to 2,000 orthopedic surgeons randomly selected from a list provided by the American Academy of Orthopaedic Surgeons. Of the 1,214 respondents, 96% (1,168) reported that they practiced defensive medicine through ordering “imaging, laboratory tests, specialist referrals or hospital admissions mainly to avoid possible malpractice liability.”
According to the study abstract, 24% of all ordered tests were ordered for defensive reasons.
The cost of defensive medicine per respondent was calculated through the mean national Medicare payment information and determined to be approximately $100,000 per respondent per year.
“Using a mean average of Medicare [Relative Value Units] and cost data, we were able to quantify the cost of defensive medicine — and we noted it was approximately $8,500 per respondent per month,” Jahangir said.
Extrapolated out to cover the 20,400 practicing orthopedic surgeons in the United States, the researchers estimated that defensive medicine cost the orthopedic field a total of more than $2 billion per year.
Need for further examination
“Spending does not equal quality,” Jahangir said. “Based on certain variables, the United States is not the top country in the world in terms of health care quality, though we do have the highest GDP percentage dedicated to it.”
The results, according to Jahangir, point toward the need for further attention to the costs of defensive medicine within the orthopedic field — as it may be a larger problem than previously thought.
“We propose the cost of defensive medicine in the practice of orthopedic surgery is $2 billion annually,” he said. “Defensive medicine is a major contributor to our rising health care costs, and I believe this study demonstrates the further need to examine this in the discussion of health care costs.” — by Robert Press
References:For more information:
- www.vanderbilt.edu
- Sethi MK, Obremskey WT, Natividad H, et al. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: A national survey study. Am J Orthop. 2012;41(2):69-73.
- A. Alex Jahangir, MD, can be reached at Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37232; 615- 322-5000; email: alex.jahangir@vanderbilt.edu.
- Disclosure: Jahangir has no relevant financial disclosure.
Perspective
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This study is yet another step in the right direction, albeit with an inherent flaw related to bias, in answering a survey containing self-serving questions. Most physicians would obviously like to see the incidence of medical malpractice litigation reduced or eliminated entirely. As scientists, physicians also naturally want to quantify the true incidence and cost of procedures and tests done solely to avoid litigation with no benefit to the patient. Those data would identify the true incidence of so-called defensive medicine.
Instead, the term “defensive medicine” has been bandied around to build support for legislative reforms aimed at conferring physician immunity for allegedly tortious acts that can constitute professional negligence. The truth is that a precise definition of what constitutes defensive medicine remains elusive. To the extent that tort law contributes to a healthy fear that the system will hold an individual accountable, what the survey identified as defensive medicine may be just what the doctor ordered, so to speak, in order to ensure quality and safety.
The study authors are to be applauded for tackling, as other authors have done in the past, one of the most difficult and vexing subjects at the intersection of the law and medical practice.