Study assesses cost of the overuse of medical tests and procedures
About 28% of the orders for three services at three hospitals were at least partially defensive by the physicians who ordered them, according to a recent study by Michael B. Rothberg, MD, MPH, a researcher with the Center for Value-Based Care Research at the Cleveland (OH) Clinic.
Rothberg and his research colleagues studied allegations about the overuse of medical tests and procedures being driven by a fear of malpractice lawsuits, which is commonly known as defensive medicine. The cost of defensive medicine has been estimated at $46 billion annually in the United States, although those costs have been measured indirectly.
The authors estimated the cost of defensive medicine on three services tests, procedures, or hospitalizations by asking physicians to estimate the defensiveness of their own orders. The authors invited 42 hospitalist physicians to complete a survey. Thirty-six physicians did. The researchers then rated 4,215 orders for 769 patients in the research letter.
Of the orders, 28% were rated as defensive. The mean cost was $1,695 per patient, of which $226 (13%) was defensive. Completely defensive orders represented about 2.9% of costs, mostly because of additional hospital days.
Rothberg and his colleagues concluded that although a large portion of hospital orders had some defensive component, "our study found that few orders were completely defensive and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform."
Access to the full study is available online at http://tinyurl.com/mvoh5ov
