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
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American Academy of Orthopaedic Surgeons