Perspective from Jack M. Bert, MD
Source/Disclosures
Disclosures: Villalobos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 14, 2020
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Regional malpractice claims may be associated with increased Medicare imaging utilization

Perspective from Jack M. Bert, MD
Source/Disclosures
Disclosures: Villalobos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Physicians living in regions with a high incidence of medical malpractice claims may be more susceptible to ordering advanced Medicare imaging as a defensive medicine strategy, according to published results.

Alexander Villalobos, MD, and colleagues from the Emory University School of Medicine analyzed claims data from a 5% sample of Medicare beneficiaries from 2004 to 2016 to find associations between regionally adjusted rates of Medicare imaging orders and paid physician malpractice claims. Villalobos and colleagues used National Practitioner Data Bank files to calculate paid claim frequencies and payout amounts, according to the study.

Villalobos infographic
"Each additional paid malpractice claim over the course of 5 years (thereby contributing to an unfavorable malpractice litigation environment) was associated with an average of 1,389 additional advanced imaging examinations in the Medicare population alone in the subsequent year."

During the sample period, nationwide Medicare imaging utilization declined by 31.4%, from 355,057 to 243,517 examinations, and overall spending declined by 47.2%, from $28,591,146 to $15,099,291. During the same period, paid medical malpractice claims declined by 46.4%, from 4.83 to 2.59 claims per 100,000 people, and payout amounts decreased by 39.6%, from $1,803,565 to $1,089,112 per 100,000 people.

After controlling for secular trends and state fixed effects with multivariate regression models, Villalobos and colleagues found a positive association between Medicare imaging utilization and the lagged number of paid malpractice claims per capita. Investigators found a 1% increase in average paid malpractice claims was linked with a subsequent 0.2% increase in imaging order, according to the lagged 5-year rolling paid malpractice averages.

States with the greatest increases in paid malpractice claims were West Virginia (+12.5%), Indiana (+11.4%) and Rhode Island (+6.0%), while states with the greatest decreases in paid malpractice claims were South Dakota (-91.0%), North Dakota (-86.9%) and Vermont (-73.9%), according to the study.

“Each additional paid malpractice claim over the course of 5 years (thereby contributing to an unfavorable malpractice litigation environment) was associated with an average of 1,389 additional advanced imaging examinations in the Medicare population alone in the subsequent year,” Villalobos and colleagues wrote in the study.

“In recent years and across the United States, overall Medicare imaging utilization and paid medical malpractice claims have both declined,” they wrote. “Nevertheless, the high costs of both remain important issues for physicians and policymakers alike, particularly as they seek to ameliorate the negative effects of defensive medicine,” they added.