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Paid malpractice claims among US physicians declined significantly

Between 1992 and 2014, there was a significant decline in paid malpractice claims, possibly due to several factors, including the passage of traditional tort reforms during this period, improvements in patient safety, how institutions and insurers resolve claims and/or the increasing prevalence of communication and resolution programs, according to research published in JAMA Internal Medicine.

“In 1986, Congress created the National Practitioner Data Bank (NPDB) to serve as a centralized database of malpractice claims paid on behalf of U.S. physicians,” Adam C. Schaffer, MD, from the division of general medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Since its inception, the NPDB has contributed to our understanding of national trends in medical malpractice payments and characteristics of risk of liability for physicians. The lack of information on physician specialties, however, has been a major limitation of analyses relying on information in the NPDB.”

Schaffer and colleagues evaluated trends in paid malpractice claims by specialty for physicians in the United States. They performed a comprehensive analysis of all paid malpractice claims (n = 280,368), with linkage to physician specialty, using data from the NPDB between Jan. 1, 1992, and Dec. 31, 2014, totaling approximately 19.9 million physician-years. Using the Consumer Price Index, the researchers adjusted all dollar amounts for inflation to 2014 dollars.

Results indicated that there was a 55.7% decline in the rate of paid claims from 1992-1996 to 2009-2014, from 20.1 to 8.9 per 1,000 physician-years (P < .001). This rate ranged from a 75.8% decline in pediatrics to a 13.5% decline in cardiology.

There was a mean compensation payment of $329,565, increasing by 23.3% from $286,751 in 1992-1996 to $353,473 in 2009-2014 (P < .001). The increases ranged from $17,431 in general practice to $114,410 in gastroenterology and $138,708 in pathology. A total of 7.6% of paid claims exceeded $1 million: 6.2% in 1992-1996 and 8% in 2009-2014. Of these claims, 32.1% involved a patient death. The most frequent allegation documented was diagnostic error, which occurred in 31.8% of paid claims and ranged from 3.5% in anesthesiology to 87% in pathology.

“From 1992 to 2014, there was a marked reduction in the rate of malpractice claims paid on behalf of physicians, with a concurrent increase in both mean payment amounts (adjusted to 2014 dollars) and the rate of catastrophic payments,” Schaffer and colleagues concluded. “There were wide differences in rates of paid claims and characteristics of the alleged injuries across specialties. A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce patient injury and physicians’ risk of liability.” – by Alaina Tedesco

Disclosure: The researchers report receiving grants from NIH and Research to Prevent Blindness.