The Costs of Defensive Medicine

As I mentioned in a previous blog, current Obamacare supporters refuse to consider the impact of liability reform. The President even said there would be no consideration for liability reform and none of the plans in writing now contain a word about liability reform.

The problem is, that liability reform is a major area for saving billions of dollars. For me as a practicing emergency medicine physician I see two major costs to the defensive medicine that now pervades our healthcare system. First, let me explain what is probably simple to most, but is relentlessly ignored by politicians supported by trial lawyers: why physicians practice defensive medicine.

No one wants to be sued. In some states, like Florida, three suits and you lose your license; there is a defined limit on the number of lawsuits you are allowed. Further, who wants to endure the costs in life sacrifice and money to get through medical school only to lose it all in a single settlement? A recent lawsuit paid a patient $60 million dollars when the plastic surgeon botched her thigh lift.^A Frivolous lawsuits and exorbitant awards cost providers and their insurance companies millions of dollars in insurance premiums. Those costs are forwarded on to the patients in increased healthcare costs and thus increased insurance premiums. But what does it do to the doctors? We go crazy ordering CAT scans and labs to make certain that once we are on the stand, we can say we did everything we could. Those additional studies intended to keep my colleagues and I out of the courtroom, are the heart of defensive medicine.

So, what do they cost? A single CAT Scan of the abdomen and pelvis costs the patient or insurance company anywhere from $1,000.00 to $2,700.00. A single CAT scan of the head costs around $600.00. Providers often order studies that they know, or are fairly certain would be negative when considering the clinical presentation and the physical exam. The financial costs of this are staggering.

In a recent poll of emergency physicians, 65% said that they could save over $500 per 8-hour shift by decreasing unnecessary tests as a part of their defensive practice. Another 16% felt they could save between $200 and $500 dollars.^B I run a fairly large Level 2 trauma center that will see 75,000 patients this year. I staff it with 9, 10 and 12-hour shifts a day. If we assume a conservative savings per shift of $400 dollars, less than a single CAT scan, then in my emergency department alone, stopping the defensive practice of medicine would save (365 x 9 x $400) $1,314,000.00. There are over 5,000 emergency departments in the country. And I can only speak for emergency medicine. What about surgeons? Family Medicine?

But there are other costs besides the added tests. If a patient has a lesser paying insurance company, especially the government payers like Medicare and Medicaid, many physicians will not see them because that third party payer's rate of reimbursement is so low, it does not cover the costs of practicing defensive medicine. You may have 6 neurosurgeons in town but none to remove your tumor because they don't take your insurance. The cost of defensive medicine then has to also be measured by the number of people who cannot access care. While this is mostly a human cost of people not getting care, it is often also financial because the decreased access to primary care forces people to the e.r., where care is mandated by the government despite the person's ability to pay. As I mentioned in a previous blog, the costs of unpaid e.r. visits are shifted to others increasing the cost of health insurance and further decreasing the pool of people who can afford the insurance.

Any discussion of revising healthcare in America must include the incredible costs of defensive medicine brought on by our current liability practices. The only way Obamacare supporters, funded by trial lawyers, will ever consider liability reform, is when the outcry of the American people reaches a level they can not ignore. So, do your part and pass on this blog and all others that address the issue.

Thanks, Mark

^A"Defensive Medicine is Real," Emergency Medicine Physician Monthly, volume 16, number 9, September 2009. Page 22.

^B"What Emergency Physicians think about health care reform," Emergency Medicine Physician Monthly, volume 16, number 9, September 2009. Page 24.