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Study: Fear of Malpractice Suits Doesn’t Change Care

Posted on November 9, 2014

Do emergency room physicians fear malpractice suits to the extent that they might order unnecessary tests? That was the question posed by a group of researchers who wondered if such unnecessary spending exists and, if so, whether legal reforms could curb it. The researchers speculated that emergency physicians practice in such an information-poor, resource-rich environment that it may lend itself to costly defensive practice. Their study, The Effect of Malpractice Reform on Emergency Department Care, was published in the Oct. 16, 2014 issue of the New England Journal of Medicine.

Study Follows Quasi-Experimental Design

Researchers reviewed records in three states—Texas, Georgia and South Carolina—that had legally changed the malpractice standard for emergency care to gross negligence. They examined the same type of records for hospital emergency rooms in neighboring control states.

Specifically, they looked at a 5% random sample of Medicare fee-for-service beneficiaries from 1997 through 2011. Using a quasi-experimental design, researchers compared patient-level outcomes before and after legislation. They controlled for characteristics of the patients, time-invariant hospital characteristics, and temporal trends. The measured outcomes were policy-attributable changes in the use of computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions.

Little to No Change Found in Care

For eight of the nine state outcome combinations tested, no policy-attributable reduction in the intensity of care was detected. Researchers also found no reduction in the rates of CT or MRI utilization or hospital admission in any of the three reform states and no reduction in charges in Texas or South Carolina. In Georgia, reform was associated with a 3.6% reduction in per-visit emergency department charges.

The study concluded that legislation had little effect on emergency department care, as measured by imaging rates, average charges and hospital admission rates. For a full text of the study, visit www.nejm.org. The study was funded by the Veterans Affairs Office of Academic Affiliations and others.