Want to Cut Costs in the ER? Pass Medical Liability Reform

Poll of Emergency Physicians Shows More Than Half Order Tests as Protection Against Being Sued

WASHINGTON, May 23, 2011 /PRNewswire-USNewswire/ -- Nearly half (44 percent) of almost 1,800 emergency physicians responding to a poll report that the biggest challenge to cutting costs in the emergency department is the fear of lawsuits. Even more respondents (53 percent) said the main reason they conduct the number of tests they do is the fear of being sued.  

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"Medical liability reform is essential to meaningful health care reform," said ACEP's president, Sandra Schneider, MD, FACEP.  "Without it, health care costs will continue to rise.  Estimates on the costs of defensive medicine range from $60 billion to $151 billion per year. That dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2 percent of all health care spending."  

In addition, more than two-thirds (68 percent) of poll respondents said there has been no improvement in the number of medical specialists willing to take call in the emergency department since health care reform legislation passed last year.  Many specialists cite the fear of being sued as one of the top reasons they will not treat emergency patients.  Emergency care is considered high-risk for liability, because patients are more seriously ill or injured and physicians often don't have access to their medical histories.   The on-call specialist shortage has been linked to emergency department deaths and permanent injury.  

"Texas offers us a great example of the benefits of tort reform," said Dr. Schneider.  "After the state passed medical liability reform, 33 rural counties have added at least one emergency physician, including 24 counties that previously had none.  Nationwide, according to the Agency for Healthcare Quality and Research, states with caps on non-economic damages saw a 3 to 4 percent decrease in health care costs."

Dr. Schneider also said patient safety has improved in Texas since liability reform.  

"Texas has achieved the second biggest improvement for emergency department wait times among all 50 states, according to a 2010 report from Press Ganey," said Dr. Schneider.  "Despite growing demand and the highest uninsured population in the nation, Texas improved access to medical care for emergency patients by enacting tort reform."

ACEP supports two pieces of legislation proposed in the U.S. House of Representatives, H.R. 5 and H.R. 157, which are both aimed at liability reform.  H.R. 157 would extend the same legal protection that physicians in the Public Health Service have to physicians who care for patients in emergency departments.  Emergency physicians are required by federal law to treat all patients, and often treat time-sensitive patients without any knowledge of their medical history.  H.R. 5 recently cleared through the House Energy and Commerce Committee and will come up for a floor vote soon.

Dr. Schneider also raised an issue related to the development of quality measures for medical care, some of which are designed to discourage the overuse of testing.  

"The federal government is making great efforts to implement quality measures, but without federal medical liability reform, physicians following the guidelines developed by the Centers for Medicare & Medicaid Services (CMS) may open themselves to litigation," said Dr. Schneider.  "For example, under new CMS guidelines, the use of head CTs is being discouraged.  Fewer head CTs will mean that physicians miss maybe 1 percent of serious head bleeds.  So a small percentage of people with head bleeds will be missed, and there are no liability protections for those physicians who may be sued as a result."  

The second largest challenge to cutting costs reported by poll respondents (19.8 percent) is the increase in uninsured patients, because no physicians will treat them.

ACEP conducted the poll from March 3 to March 11, 2011.  E-mails were sent to 20,687 emergency physicians, and 1,768 responded.  The survey has a theoretical sampling error range of plus/minus 2.23.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.  


Download a copy of the complete ACEP poll results

SOURCE American College of Emergency Physicians