Malpractice Reform Does Not Change Physician Practice Patterns

Clinical question: Do malpractice reform policies shift physician practice patterns toward lower utilization of healthcare resources?

Background: Physician-reported fears of lawsuits lead to defensive medicine practices, which contribute to high healthcare costs. It is unclear whether malpractice reform legislation reduces these costly physician practice patterns. The ED is a high-risk environment that may promote defensive medicine practices and is the focus of recent malpractice reform legislation in Texas, Georgia, and South Carolina.

Study design: Case-control.

Setting: EDs in Texas, Georgia, South Carolina, and adjacent states.

Synopsis: Using a 5% random sample of Medicare claims from 1997-2011, the investigators evaluated the impact of recent malpractice reform legislation on intensity of practice by ED physicians, as defined by rates of use of advanced imaging (computed tomography [CT] or magnetic resonance imaging [MRI]), hospital admission, and average charges. ED claims from the three reform states (Texas, Ga., and S.C.) were compared to neighboring (control) states.

Adjusted analysis of 3,868,110 ED visits from 1,166 eligible hospitals demonstrated no significant reductions in CT/MRI utilization, rates of hospital admission, or (in two of the three reform states) average per-visit ED charges attributable to policy reforms.

Bottom line: Broadly protective malpractice reform had minimal impact on emergency physicians’ intensity of practice, as measured by rates of advanced imaging use, hospital admission, and average charges. Such “pro-physician” legal reforms may be inadequate in isolation to significantly reduce costs.

Citaton: Waxman DA, Greenberg MD, Ridgely MS, Kellermann AL, Heaton P. The effect of malpractice reform on emergency department care. N Engl J Med. 2014;371(16):1518-1525.