From: deputyfife23x@gmail.com   
      
   University of Southern California    
      
   Health    
      
      
   Doctors who spend more on patients face lower malpractice claim risk    
      
   Physicians do more for patients because they believe it reduces liability   
   risk, study finds    
      
   BY Emily Gersema    
   NOVEMBER 4, 2015    
      
      
   The findings raise concerns that malpractice risk could be an impediment to   
   health care reform. (Photo/Philip Channing)    
   Physicians who spend more money and resources conducting tests and procedures   
   for patients are less likely to be sued for malpractice, according to a new   
   study that indicates "defensive medicine" may work.    
      
   Published Nov. 4 by The BMJ, the study by researchers at USC, Harvard   
   University and Stanford University noted that doctors in surveys worldwide   
   said they practice defensive medicine -- doing more for patients because they   
   believe it reduces liability    
   risk. The study affirms this widely held assumption, tying higher spending to   
   lower malpractice claim rates through an analysis of Florida physician and   
   claims data.    
      
   Researchers also gave special attention to Caesarean deliveries due to ongoing   
   concerns that many C-sections are performed predominantly due to physicians'   
   malpractice concerns. The link was obvious here, too: The more C-sections that   
   an obstetrician    
   performed, the less likely he or she was to face malpractice complaints.    
      
   The findings raise concerns that malpractice risk could be an impediment to   
   health care reform.    
      
   More and more we are relying on physicians to help eliminate wasteful spending   
   in health care.    
      
   Seth Seabury    
      
   "More and more we are relying on physicians to help eliminate wasteful   
   spending in health care. However, if physicians perceive that lowering   
   spending will subject them to greater malpractice risk, it will be that much   
   harder to move the needle on health    
   care spending," said Seth Seabury, an author on the study from the Leonard D.   
   Schaeffer Center for Health Policy and Economics at USC.   
      
   Financial incentives    
   Legislators and federal officials have tried to remove financial incentives   
   for physicians and hospitals to provide excessive treatment through payment   
   reform.    
      
   "One of the reasons we are moving away from the fee-for-service model is to   
   remove the incentives of physicians to spend more. But if spending continues   
   to shield physicians from liability risk then that incentive will still be   
   there," said Seabury, who    
   also is an associate professor of research at the USC School of Pharmacy and   
   at the Keck School of Medicine of USC's Department of Emergency Medicine.    
      
   A doctor's effort can influence the outcome of a malpractice lawsuit.    
      
   "Higher spending may signal to patients, judges and juries that despite an   
   error, the doctor did everything possible to help," said Anupam Jena, the   
   study's lead author, who is a Harvard Medical School associate professor in   
   the Department of Health Care    
   Policy.    
      
   Study details    
   The researchers obtained data from the Florida Agency for Health Care   
   Administration and from the Florida Office of Insurance Regulation for the   
   years 2000 to 2009. The databases included 24,637 physicians with a role in an   
   estimated 19 million hospital    
   discharges and 4,342 malpractice claims.    
      
   The researchers analyzed the doctors' malpractice and adjusted hospital   
   spending rates in "physician years" -- the course of a year in which any given   
   physician appeared in the data. Researchers found an inverse correlation: As   
   adjusted hospital spending    
   per physician year increased, the malpractice rate dropped.    
      
   In internal medicine, for example, the malpractice claim rate per physician   
   year was 1.5 percent, when spending was $19,725 per hospitalization. The claim   
   rate was even lower -- 0.3 percent -- when spending reached $39,379 per   
   hospitalization.    
      
   In obstetrics and gynecology, malpractice claim rates were significantly lower   
   when C-section deliveries were high. The malpractice claim rate fell from 5.7   
   percent to 2.7 percent when the average adjusted C-section rate per   
   obstetrician year rose from 5.   
   1 percent of all deliveries to 31.6 percent.    
      
   Unanswered questions    
   The researchers acknowledged some limitations that raised questions worth   
   further study:    
      
   The data didn't reveal physician motivation or proclivity. Perhaps some   
   doctors were especially precautious to reduce errors in patient care. In those   
   cases, spending might not have been wasteful.    
   The data couldn't distinguish between whether the increased spending was   
   associated with better outcomes or simply reduced the likelihood of a   
   malpractice claim for a given outcome.    
   The study utilized only inpatient data; however, half of all paid malpractice   
   claims are for inpatient incidents.    
   The physician of record might not have been responsible for total spending on   
   a patient.    
   The study did not account for situations in which a doctor might avoid   
   treating a patient because he or she represents a high liability risk.    
   The data were from a single state, Florida, whose health care and malpractice   
   systems may differ from those of other states.    
   Possible solutions    
   Prior studies have suggested that malpractice claims are often filed due to   
   issues with the physician-patient relationship. Malpractice claims also are   
   often based on a doctor's failure to do something that should have been done   
   (an error of omission) or    
   doing something that shouldn't have been done (an error of commission).    
      
   "We need reforms that disentangle malpractice risk from spending, so that   
   physicians who practice safe and effective medicine don't feel the need to   
   spend more for defensive purposes," Jena noted.    
      
   The study's co-authors were Lena Schoemaker and Jay Bhattacharya, both of the   
   Stanford University School of Medicine. The study was funded by an Early   
   Independence Award (1DP50D017897-01) from the National Institutes of Health,   
   awarded to Jena.    
      
      
      
      
   https://news.usc.edu/88360/doctors-who-spend-more-on-patients-fa   
   e-lower-malpractice-claim-risk/   
      
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