Nearly a third of the orders that the surveyed physicians placed were
defensive on some level. The researchers argue that clear communication about
evidence-based guidelines and tort reform that would protect clinicians when
they follow those guidelines would help reduce providers' fear and improve
patient care.
Fear of frivolous lawsuits may be so pervasive that it has changed what
is considered an acceptable diagnostic approach, said Dr. Michael Rothberg,
vice chair for research in the Medicine Institute of the Cleveland Clinic and
lead author of a summary of the findings published in JAMA Internal Medicine.
“Some people might say it's defensive, and other people might think
it's the standard of care,” Rothberg said. “There's really more of a culture
about how people treat a particular problem, and many may not recognize it as
being defensive.”
The study found 28% of orders and 13% of costs were judged to be at
least partially defensive among the hospital medicine services at three
institutions within one Massachusetts health system. About 2.9% of costs were
considered to be completely defensive, meaning the only reason a test was
ordered was fear of a lawsuit. Most costs were associated with the hospitalists
prolonging a patient's hospital stay.
Thirty-six physicians from Baystate Health System's Medical Center in
Springfield, Mass., Franklin Medical Center in Greenfield, Mass., and Mary Lane
Hospital in Ware, Mass., rated 4,215 orders for 769 hospital inpatients.
The results suggested that physicians aren't reliable judges of what's
driving their own decisions. Physicians who were most inclined to describe
orders as influenced by liability fears did not actually drive more costs or
order more tests than their colleagues who said they “practiced in a very
nondefensive way,” Rothberg said.
Republicans have argued that the Obama administration and congressional
Democrats missed an opportunity to tackle tort reform in the Patient Protection
and Affordable Care Act, which conservative policy experts and many physicians
say would do more to improve the efficiency of the U.S. healthcare system than
any of the law's payment and delivery reforms.
The reform law did authorize $50 million to fund grants to states to
develop and test alternatives to medical liability litigation.
The Agency for Healthcare Research and Quality has said in a report
(PDF) that one demonstration program achieved a 40% decline in the number of
malpractice claims, an 80% reduction in the time it took to settle cases and a
20% decrease in defensive medicine services.
Still, when the American College of Surgeons hosted its third annual
leadership and advocacy summit in Washington this past spring, medical
liability reform was a primary topic.
Attendees called on lawmakers to support additional initiatives that
lawmakers have introduced to curb frivolous lawsuits. For example, the Saving
Lives Saving Costs Act (PDF) would give legal cover to providers who adhere to
physician developed best-practice and appropriate-use guidelines from groundless
lawsuits. The Health Care Safety Net Enhancement Act protects emergency on-call
specialists. The Good Samaritan Health Professionals Act protects health
professionals who provide voluntary care in response to federally declared
disasters.
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