More study of alternative tort reform needed to curb defensive medicine, researchers say

The presence of medical malpractice liability caps doesn't necessarily reduce physicians' practice of defensive medicine, according to a study published in the Aug. 5 Health Affairs.

The research, led by Dr. Emily Carrier, an emergency physician and senior health researcher at the Center for Studying Health System Change, and funded by National Institute for Health Care Reform, was the first to link physicians' self-reported perceptions of malpractice risk to their actual ordering behavior, Family Practice News reported.

In most cases, physicians' higher levels of concerns with malpractice suits were associated with more advanced imaging tests and referrals to the emergency room. However, claims data showed that these services often went up in states with medical liability damage caps.

The finding may be a case of "reverse causality," according to researchers. As Family Practice News explained, in states where there are high levels of defensive medicine, lawmakers are more likely to adopt a damage cap.

Because physician decision-making in whether to order a test is so complex, Carrier and colleagues acknowledge that their study offers no definitive answers. Carrier stated that she hopes, however, that her work will help spurn more study of alternative tort reform strategies such as "safe harbors" for physicians who follow evidence-based practice guidelines.

In a June report, the Center for American Progress proposed similar reforms to medical malpractice policies to protect physicians and reduce the cost of defensive medicine, FierceHealthcare reported.

"We certainly aren't coming down on one side or the other," Carrier said. "We're just showing that given our data, we may need to rethink some previous conclusions and find a different approach."

To learn more:
- read the article from Family Practice News
- see the abstract from Health Affairs