“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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