13% of Hospital Costs Motivated by Malpractice Fear

In a study of 3 hospitals in Massachusetts, more than a quarter of patient orders were considered partially defensive medicine, but they only accounted for 13% of costs, according to a summary published in JAMA.

Defensive medicine is the overuse of tests and procedures because of fear of malpractice litigation, and it is estimated to cost $46 billion annually in the United States. According to the data compiled from 39 participating physicians at Baystate Medical Center, Baystate Franklin Medical Center, and Baystate Mary Lane Hospital, just 13% of hospital costs could be considered at least partially defensive.

The physicians were asked to look through their orders from the previous day and indicate on a 5-point scale (with 0 being “not at all defensive” and 4 being “completely defensive”) the extent to which each one was ordered primarily because of malpractice concerns.

Overall, there were 4215 orders for 769 patients. The physicians generated a median of 3 orders per patient and 97 per physician, and 28% were considered defensive. Only 4 out of the 39 physicians identified no defensive orders, while 21 rated at least 1 order as “mostly defensive.”

Being more defensive did not increase costs per patient, the authors found. Compared with physicians with fewer defensive orders, those with at least 10% defensive orders placed a similar number of orders (5.4 vs 4.9) and generated similar costs per patient ($1679 vs $1700).

Completely defensive orders represented 2.9% of hospital costs. According to the investigators, most costs were due to potentially unnecessary hospitalizations, which accounted for 82% of all defensive orders.

Based on the information on demographics and attitudes toward defensive medicine gathered on the physicians, there were no factors were associated with defensive orders or cost.

“Defensive medicine practices varied substantially, but physicians who wrote the most defensive orders spent less than those who wrote fewer such orders, highlighting the disconnect between physician beliefs about defensive medicine and their contribution to costs,” the authors concluded.