We all know it happens – medical imaging scans of questionable clinical value, performed not to improve patient diagnosis but to defend clinicians in the event of malpractice litigation. A new study in AJR supports the idea that defensive medicine is driving up imaging use by finding a link between malpractice reform and lower emergency imaging utilization.
The proliferation of imaging technology throughout the healthcare enterprise – and especially in the emergency setting – gives clinicians a powerful tool that’s just too tempting not to use.
- Head CT scans can quickly rule out patients who might have a hemorrhagic stroke, for example, while cardiac CT angiography is showing its value for working up patients with chest pain.
But with great power comes great responsibility. Unnecessary imaging not only drives up healthcare costs but can expose patients to additional radiation as well as complications from working up suspicious findings.
- Medical-legal experts speculate that malpractice reform through tools such as damage caps could tamp down defensive medicine by limiting physicians’ legal exposure to lawsuits in the event they make a mistake.
In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute tested the idea by analyzing 630k Medicaid encounters for patients with headache presenting to the emergency department in 2019.
- They then correlated head and neck imaging volume to various factors that could influence utilization, including whether states had implemented tort reform.
Their analysis discovered that emergency imaging utilization was less likely to occur…
- In states with laws on “several liability” (in which parties are only responsible for their own share of damages) (OR = 0.68).
- In states with malpractice damage caps (OR = 0.79).
- In states with greater mean malpractice payment (although the effect size was minimal; OR = 0.99).
A couple other interesting findings included…
- Referring physicians other than emergency medicine were far more likely to order more imaging (OR = 8.45).
- Facilities with fewer than 100 beds were less likely to order imaging (OR = 0.65).
The Takeaway
The new findings linking malpractice reforms with lower emergency imaging use confirm what many of us have already suspected. Whether they lead to health policy reforms remains to be seen.
