New Study Estimates Cost of Defensive Medicine

Data from a new study suggests that defense medicine—and the cost that’s passed on to the healthcare system—is alive and well in orthopedics.

In a first-ever national survey of orthopedic surgeons, 96 percent said they have practiced defensive medicine—the ordering of tests, referrals to specialists and hospital admissions primarily to avoid liability and without significant benefit to patients—according to a new study presented at this year’s annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). The study estimates the annual cost of defensive orthopedic care at $2 billion.

In September 2010, researchers asked 2,000 orthopedic surgeons to complete a Web-based survey on defensive medicine. The orthopedic surgeons were chosen randomly from the AAOS database. Of the 1,214 respondents (61 percent of the total pool), 96 percent responded that they had ordered imaging or laboratory tests, referred patients to specialists, or approved hospital admissions primarily to avoid possible malpractice liability.

More specifically, 24 percent of tests were ordered for defensive reasons: 19 percent of radiography tests, 26 percent of CT scans, 31 percent of MR images and 44 percent of ultrasounds. Participating orthopedic surgeons also acknowledged that defensive medicine was the motivation behind 35 percent of specialist referrals, 23 percent of laboratory tests and 18 percent of biopsies.

Defensive hospital admissions averaged 7 percent each month.
Using the average national Medicare payment information from the 2011 Current Procedural Terminology (CPT) code reimbursement data, the cost of defensive medicine per orthopedic surgeon respondent was approximately $8,500 per month or $100,000 per year, representing 24 percent of a physician’s annual spending. Given the U.S. Department of Labor’s statistic of 20,400 practicing orthopedic surgeons in the U.S., investigators estimate the national, annual cost of defensive medicine for the specialty of orthopedic surgery at $173 million per month or $2 billion each year.

The study results show that physicians “are clearly concerned about malpractice issues, and they’re adjusting their practice procedures based on that fear,” said Manish K. Sethi, M.D., lead author of the study, and co-director of the Vanderbilt Orthopaedic Institute Center for Health Policy. Eliminating defensive medicine is “an easy thing we can do to lower costs.”

Sethi has no conflicts of interest to disclose. Sethi previously was involved in a similar study of orthopaedic surgeons in Massachusetts that found comparable results, but this is the first to demonstrate defensive medicine practices are common nationwide.

According to Douglas W. Lundy, MD, FACS, chairman of the AAOS Medical Liability Committee said: “Defensive medicine drives up the cost of patient care and limits patient access to specialty care, neither of which are in the interest of our patients who deserve the best and least costly care possible. Unfortunately, the current legal climate forces good doctors to order these tests and practice defensive medicine.”