State-level malpractice reforms for emergency physicians produced no discernible reduction in the intensity of care, according to a RAND Corp. study in the New England Journal of Medicine.
The study looked at emergency care of Medicare fee-for-service in the reform states--Texas, Georgia and South Carolina--and in three neighboring states between 1997 and 2011. The reforms were passed in the mid-2000s. The findings: no reduction in the rate of CT or MRI utilization or hospital admissions. Only Georgia recorded lower (3.6 percent) per-visit emergency department charges.
"If your goal is cost savings, if you believe there is a lot of pure waste going on, then malpractice reform is a blind alley," chief study author Daniel Waxman, M.D., told Reuters Health. Blaming defensive medicine "distracts people from looking for other avenues" that might reduce costs, he said in the Reuters article.
Meanwhile, even with malpractice reform in play, 8 percent of Georgia physicians--2,536 out of 29,500--lack malpractice liability insurance.
Earlier this week an analysis in BMJ blamed overtreatment more on "intolerance of both uncertainty and error" than on fear of malpractice. The authors cited a "shame and blame" medical culture that needs to stop thinking more treatment is always better.