The high cost of defensive medicine

Defensive medicine, the practice of ordering tests and referrals more out of concern for liability than for the benefit of patients health, is an expensive convention. According to a recent survey of orthopedic surgeons, 30 percent of the tests and referrals ordered in this specialty are unnecessary, resulting in an estimated cost of greater than $2 billion in the U.S. each year.

The survey was conducted by Vanderbilt University s Dr. A. Alex Jahangir and colleagues, who sent questions to 2,000 orthopedic surgeons across the country, 1,241 of whom responded. Using Medicare reimbursements for the categories of services and procedures covered in the survey, researchers ultimately calculated that almost one-quarter of the total cost could be attributed to liability concerns. According to these findings, the greatest percentage of defensive medicine is comprised of MRIs, ultrasound studies, sub-specialty referrals and consultations, CT scans, and lab tests although the survey respondents named numerous others. The respondents also indicated that 7 percent of their hospital admissions were driven by liability concerns.

Ironically, amid all this hyper-precautionary testing, high-risk patients fare the worst. Seventy percent of the surgeons responding to the survey reported that they reduced the number of high-risk patients they d taken on in the past five years, while 84 percent indicated that they have reduced the number of high-risk procedures they perform.

Overall, 77 percent of the respondents said they would order fewer tests and procedures if there was significant medical liability reform.

The numbers are especially jarring, given that the question of how to make medical care more affordable and accessible is a contentious topic in the U.S. As one medical liability spokesman for the American Association of Orthopedic Surgeons put it, Defensive medicine drives up the cost of patient care and limits patient access to specialty care.

Defensive medicine takes a huge toll on our national healthcare economy, says ACSH s Dr. Gilbert Ross. And even worse, while we all pay for these unnecessary tests, low-income patients and high-risk patients are increasingly cut off from the care they need.

How do we curtail the practice of defensive medicine? Dr. Jahangir believes that evidence-based clinical practice guidelines would be an effective step. While such guidelines are controversial amounting to cookbook medicine in the eyes of some Dr. Ross observes that widespread adoption of agreed-upon standards of care and treatment would indeed help protect practitioners from frivolous lawsuits. And Dr. Ross, for his part, wishes that medical tort reform were slated as part of the country s efforts to provide affordable care to its people. Some credible experts have put the overall cost of defensive medicine in the neighborhood of a hundred billion dollars, he says. It s a shame not to address it, as if ignoring the problem will make it go away.