Study Finds Higher Doctor Spending Levels Tied To Lower Malpractice Risk

Researchers at USC, Harvard and Stanford universities found that “defensive medicine” may work for physicians, but possibly at the cost of undermining health care reforms.

Contact: Emily Gersema, (213) 740-0252 or gersema@usc.edu

Physicians who spend more money and resources conducting tests and procedures for patients are less likely to be sued for malpractice, according to a new study that indicates “defensive medicine” may work.

Published Wednesday, Nov. 4 by BMJ, the study by researchers at USC, Harvard University and Stanford University noted that doctors in surveys worldwide have said they practice defensive medicine — doing more for patients because they believe it reduces liability risk. The study affirms this widely-held assumption, tying higher spending to lower malpractice claim rates through an analysis of Florida physician and claims data.

Researchers also gave special attention to Caesarean deliveries due to ongoing concerns that many C-sections are performed predominantly due to physicians’ malpractice concerns. The link was obvious here, too: The more C-sections that an obstetrician performed, the less likely he or she was to face malpractice complaints.

The findings raise concerns that malpractice risk could be an 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,” said Seth Seabury, an author on the study from the USC Schaeffer Center for Health Policy and Economics.

Legislators and federal officials have tried to remove financial incentives for physicians and hospitals to provide excessive treatment through payment reform.

“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,” said Seabury, who also is an associate professor of research at the USC School of Pharmacy and at the Keck School of Medicine of USC’s Department of Emergency Medicine.

A doctor’s effort can influence the outcome of a malpractice lawsuit.

“Higher spending may signal to patients, judges and juries that despite an error, the doctor did everything possible to help,” said Dr. Anupam Jena, the study’s lead author who is a Harvard Medical School associate professor in the Department of Health Care Policy.

The researchers acknowledged some limitations that raised questions worth further study:

• The data didn’t reveal physician motivation or proclivity. Perhaps some doctors were especially precautious to reduce errors in patient care. In those cases, spending might not have been wasteful.

• The data couldn’t distinguish between whether the increased spending was associated with better outcomes or simply reduced the likelihood of a malpractice claim for a given outcome.

• The study utilized only inpatient data; however, half of all paid malpractice claims are for inpatient incidents.

• The physician of record might not have been responsible for total spending on a patient.

• The study did not account for situations in which a doctor might avoid treating a patient because he or she represents a high liability risk.

• The data were from a single state, Florida, whose health care and malpractice systems may differ from other states’.

Prior studies have suggested that malpractice claims are often filed due to issues with the physician-patient relationship. Malpractice claims also are often based on a doctor’s failure to do something that should have been done (an error of omission), or doing something that shouldn’t have been done (an error of commission).

“We need reforms that disentangle malpractice risk from spending, so that physicians who practice safe and effective medicine don’t feel the need to spend more for defensive purposes,” Jena said.

The study’s co-authors were Lena Schoemaker and Jay Bhattacharya, both of the Stanford University School of Medicine.  The study was funded by an Early Independence Award 1DP50D017897-01 from the National Institutes of Health, awarded to Jena.

Read the study.