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Providers whose colleagues have had malpractice reports may be more likely to order advanced imaging

Dan P. Ly

The rates at which physicians ordered advanced imaging during evaluation and management visits significantly increased shortly after a colleague was reported for injury or malpractice, but not in the long term, according to a study published in JAMA Internal Medicine.

“The cumulative risk for physicians of facing a malpractice claim is high across all specialties,” Dan P. Ly, MD, MPP, of the Interfaculty Initiative in Health Policy at Harvard University, wrote. “The perception of this risk may drive defensive medicine, including the use of diagnostic imaging. Certain events, such as injury reports against one’s practice peer, may increase the perception of this risk.”

To determine if injury reports are tied to increased use of advanced imaging, Ly analyzed claims from Medicare beneficiaries in Florida between 2009 to 2013 claims. He reviewed a random 20% sample of beneficiaries who were linked to injury reports on Florida physicians through their physician’s practice.

Medicare data were used to identity advanced imaging testing that occurred within 7 days of an evaluation and management visit to primary care physicians and specialists for those aged 65 years or older.

Tax data were used to identify physician practices, with a focus on those with at least one injury report during the study period. Ly looked at physician data four quarters before and four quarters after the report was made against a peer physician.

A total of 361 physicians who had a practice peer with an injury report were included in the study sample, accounting for 2,918 physician quarters.

For physicians who had a peer with an injury report, the mean advanced imaging rate was 2.3 per 100 evaluation and management visits.

The rate of advanced imaging after an injury report associated with a peer physicians was 0.78 per 100 visits higher (95% CI, 0.14-1.42) in the quarter after the report was made compared with the quarter prior to the report. In the second quarter after an injury was reported, the rate of advanced imaging was not significantly different among practice peers.

“The evidence is somewhat mixed regarding whether objective measures of malpractice risk influence a physician’s practice of defensive medicine or practicing medicine in such a way as to reduce medical liability,” Ly told Healio Primary Care. “Instead, it may be that perceptions of malpractice risk, which could be largely unrelated to these objective measures, drive much of what is deemed defensive medicine.”

“My findings showing that physicians respond to injury reports against their colleagues by increasing their use of diagnostic imaging is consistent with this possibility, as these injury reports may increase a physician’s perception of the risk of malpractice even if the actual risk has arguably not increased,” he continued.

Ly told Healio Primary Care that although his study may not apply to those other than elderly patients and physicians in Florida, he felt that his results could be seen in other populations and locations. – by Erin Michael

Disclosures: Ly reports no relevant financial disclosures.