Navigation Links
Health care spending: Study shows high imaging costs for defensive purposes
Date:2/15/2011

Nearly 35 percent of all the imaging costs ordered for 2,068 orthopaedic patient encounters in Pennsylvania were ordered for defensive purposes, according to a new study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

For many years now, some physicians have ordered specific diagnostic procedures that are of little or no benefit to a patient, largely to protect themselves from a lawsuit. Until now, however, efforts to actually measure defensive medicine practices have been limited primarily to surveys sent to physicians. Such surveys would simply ask whether or not that individual actually practiced defensive medicine.

"This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time prospectively done," says John Flynn, MD.

Flynn, who is Associate Chief of Orthopaedic Surgery at Children's Hospital of Philadelphia, says that many lawsuits hinge on the plaintiff's lawyer's claim that the doctor should have ordered extra diagnostic testing. "And such a claim may be the driving force of so much of the defensive test ordering."

According to Flynn, 72 orthopaedic surgeons, who are members of the Pennsylvania Orthopaedic Society, voluntarily participated in this study, which included some 2,068 patient encounters throughout the state of Pennsylvania. Most patients in this study were adults. The study found that 19 percent of the imaging tests ordered were for defensive purposes. Defensive imaging was responsible for $113,369 of $325,309 (34.8 percent) of total imaging charges for this patient cohort, based on Medicare dollars. The overall cost of these tests was 35 percent of all imaging ordered because the most common test was an MRI, an imaging test which costs more than a regular X-ray.

One piece of this problem to remember, Flynn says, is that the legal environment that drives physicians to order additional tests has an effect on patients too, in a way that involves more than costs. "Patients are sometimes put through tests that maybe otherwise would not be ordered."

The finding from this research that surprised Flynn the most was that surgeons were more likely to practice defensively if they had been in practice for more than 15 years.

"This was counterintuitive," he says. "I thought that young doctors would come out of medical school immediately after training, be less confident because they weren't experienced, and order more defensive tests. Then, as they become more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests."

"In fact, the opposite was true. We found that in Pennsylvania at least a surgeon's defensive nature gets worse over time. In this legal environment, orthopaedic surgeons order more imaging tests of a defensive nature, because over time they become more concerned that someone is going to second guess or sue them."

Flynn says that medical liability awards typically are given because of the severity of a bad outcome, and not necessarily because of negligence. In fact, a May 2006 study published in the New England Journal of Medicine (Studdert DM) showed that 37 percent of claims did not involve medical errors, and in 3 percent of claims, no injury occurred at all.

Flynn pointed to various studies that show that defensive medicine, in general, is quite prevalent. One such study in the June 2005 Journal of the American Medical Association (Studdert DM) reported that almost 93 percent of 824 physicians in Pennsylvania responding to a survey practiced defensive medicine.

"Ideally, as a next step, we would hope to try to get a broader national picture using this prospective practice audit methodology, so we could get a better sense of the true costs of defensive imaging in orthopaedics," says Flynn.

"Ultimately, if you had doctors from multiple specialties from OB/Gyn to Neurosurgery to Emergency Medicine do this type of practice audit, you could accurately quantify how much of our nation's healthcare resources are wasted on defensive medicine."


'/>"/>

Contact: Lauren Pearson
pearson@aaos.org
847-384-4031
American Academy of Orthopaedic Surgeons
Source:Eurekalert

Related medicine news :

1. 4.7 million Californians to gain coverage under health reform, new study estimates
2. Obesity and knee osteoarthritis shorten healthy years of life
3. Eating Breakfast May Lead Teen Moms to Better Health
4. Healthy patients at high risk of cardiac death identified
5. Scott & White Healthcare -- Round Rock performing surgery without incisions for heartburn
6. Pedal Your Way to Better Health, at Work
7. Stars Strut on the Runway for Womens Heart Health
8. New mode of dementia care improves health, lowers hospitalization rates
9. Coastal Canadians living in high-risk neighborhoods in poorer health: Study
10. Key to better health care may be a walk in the park
11. Pathway Leading to Health Declines of Aging Identified
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... "With 30 ... their specific project," said Christina Austin - CEO of Pixel Film Studios. , ... and all within Final Cut Pro X . Simply select a ProHand generator ...
(Date:6/25/2016)... ... June 25, 2016 , ... Dr. Calvin Johnson ... Recently, he has implemented orthobiologic procedures as a method for treating his patients. ... the first doctors to perform the treatment. Orthobiologics are substances that orthopaedic surgeons ...
(Date:6/24/2016)... ... June 24, 2016 , ... A recent article ... are unfamiliar with. The article goes on to state that individuals are now more ... these less common operations such as calf and cheek reduction. The Los Angeles area ...
(Date:6/24/2016)... ... ... was in a crisis. Her son James, eight, was out of control. Prone to extreme ... “When something upset him, he couldn’t control his emotions,” remembers Marcy. “If there was ... other children and say he was going to kill them. If we were driving ...
(Date:6/24/2016)... CA (PRWEB) , ... June 24, 2016 , ... ... is now offering micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience ... Damon brackets , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... INDIANAPOLIS , June 23, 2016 ... Tomorrow,s Leaders Scholarship is any indication, the future is ... online at www.diabetesscholars.org by the Diabetes Scholars ... in the way of academic and community service excellence. ... program since 2012, and continues to advocate for people ...
(Date:6/23/2016)... LONDON , June 23, 2016 ... environments  Oticon , industry leaders in ... the launch of Oticon Opn ™, the world,s ... world of possibilities for IoT devices.      ... Opn, Oticon introduces a number of ,world firsts,: ...
(Date:6/23/2016)... , June 23, 2016 The vast ... an outpatient dialysis facility.  Treatments are usually 3 times ... hours per visit, including travel time, equipment preparation and ... patient, but especially grueling for patients who are elderly ... a skilled nursing and rehabilitation centers for some duration ...
Breaking Medicine Technology: