Defensive medicine may only account for 13% of hospital costs

About 13 percent of the costs incurred by hospitals can be attributed to the practice of defensive medicine--tests and treatments that aren't medically necessary but ordered to prevent lawsuits, according to a new study in the journal JAMA Internal Medicine.

That number, if accurate, contradicts a survey of hospital executives earlier this year that concluded as much as a third of medical costs are due to defensive medicine.

The JAMA study focused on three hospitals in the Baystate system in Massachusetts. Researchers from the Center for Value-Based Care Research at the Cleveland Clinic zeroed in on more than 4,200 tests and other medical procedures ordered by 39 physicians for 769 patients.The physicians were asked to review the orders and place them on a five-point scale to rank the level of defensive medicine each order represented.

Altogether, about 28 percent of all of the orders were considered defensive in one way or another. Only three physicians identified no medical orders that were defensive in any way, but 21 identified orders they mostly considered defensive.

Orders that were considered mostly defensive contributed nearly 3 percent to total hospital costs. However, those physicians who made orders 10 percent or more of the time for defensive purposes only spent slightly more money per patient ($21) when compared to their less defensive colleagues.

But many instances of completely defensive medicine were linked to unnecessary hospitalization, which drove up costs far more quickly than other kinds of medical orders. As a result, $226 was added to the mean cost of treating each patient, up from $1,469 if no defensive medicine was practiced at all, Medscape Multispecialty reported.

However, some medical experts believe other factors come into play regarding ordering additional services other than the fear of being sued. Those include an innate sense that one patient is a little sicker than another and needs closer attention. "I've frankly come to the conclusion that you can't measure defensive medicine," Howard Brody, M.D., director of the Institute for the Medical Humanities at the University of Texas, told Medscape Multispecialty.

To learn more:
- here's the study abstract
- check out the Medscape Multispecialty article
 

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