For years, physicians and health policy experts have assumed that doctors practice defensive medicine because they’re afraid of malpractice lawsuits. However, a recent study shows that this may not always be the case.

The Effect of Malpractice Reform on Emergency Department Care,” appears in the New England Journal of Medicine. This study focused on the influence of changes in the behavior of emergency department (ED) physicians following malpractice law reforms in Texas, Georgia and South Carolina. Texas changed its malpractice standard for emergency care to “willful and wanton negligence” in 2003 while Georgia and South Carolina changed their standards to “gross negligence” in 2005. From a legal standpoint, these two standards are considered identical.

ED physicians often cite imaging procedures as examples of defensive medicine practices. Researchers studied the number of CT scans, MRIs, and inpatient admissions that ED physicians ordered for a sample of Medicare fee-for-service patients in the three states between 1997 and 2011. Researchers also studied per-visit charges as a representation of the intensity of services provided. The study compared patient outcomes before and after the passage of malpractice reform in Texas, South Carolina, and Georgia, as well as in surrounding states, in order to isolate the effects of the malpractice reform legislation.

After subjecting the data to regression analysis, the researchers could find no decrease in the rates of CT use, MRI use, or hospital admission in any of the three reform states. There was also no reduction in per-visit charges in Texas or South Carolina. Georgia, however, saw a reduction of 3.6%.

Some physicians maintain that their own results challenge the validity of the claims made by this study. They argue that the use of emergency department imaging isn’t affected by malpractice reform alone. Although the study concentrated on ED physicians, the results have greater implications for the debate over whether or not protecting doctors from malpractice lawsuits could reduce defensive medicine practices, and thereby reduce overall medical costs for the entire nation.

Author: Lauren Daniels

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