Today’s Managing Health Care Costs Number is 4x
Here’s a headline from Medscape late last fall that strikes fear in my heart:
“High-Spending Doctors Less Likely to Be Sued”
The BMJ article referenced concludes: (Harvard Link)
Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim
Internists in the bottom quintile of hospital costs have a rate of malpractice suits four times as high as those with the highest quintile of hospital costs.
It gets worse too. Obstetricians with higher Cesarean Section rates had lower rates of malpractice suits.
Oy!
The authors list limitations of the study
- No risk adjustment for patient severity of illness
- Measured only inpatient costs
- No information on why some physicians had higher resource use
- The hospital attending of record might not be the doctor who really cared for the patient in academic medical centers
- No measure of patient selection
- Measured hospital charges (not allowable amounts)
- Restricted to Florida only
I’d add some additional limitations. This is filed malpractice claims –and the vast majority of filed claims are dismissed. Given the time lag it would have been nice to see the correlation with closed claims payments. Note that study used data from 2000-9, when the rate of CS was lower than it is today. The total charges of hospitalization reflects both utilization and the hospital chargemasters, Expensive academic medical centers might be associated with lower risk of malpractice - even if their physicians do not order 'extra' services. .
Still, this is a worry. If doing more C-Sections means the risk of malpractice suit is genuinely lower, it will be difficult indeed to convince obstetricians to reach for the “optimal” C-S rate. If expensive hospitalizations really is a good proxy for resource overuse, this will make it hard to convince physicians across specialties to stop overusing resources! It especially worries me that this finding was true across all specialties (except family medicine, where the numbers were small and there are very few hospitalizations or lawsuits)
Physicians should keep in mind that adverse malpractice verdicts and settlements have diminished substantially in the last decade, too. See below for this shown graphically. Policymakers should keep in mind that practicing physicians are devastated by malpractice suits even if they prevail in court - and in many specialties the likelihood of being sued is quite high.
I’d look for researchers to repeat this study in other geographies. If doctors who do less get sued more – we might need to find the solution within the tort process rather than ir ub addition to payment reform.
