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In orthopedic surgery, defensive medicine takes a $2 billion toll

by Brendon Nafziger, DOTmed News Associate Editor | February 10, 2012
Almost a quarter of all imaging tests ordered by orthopedic surgeons are done so for "defensive" reasons, and the cumulative work by orthopedists to avoid malpractice liability might cost the U.S. health care system an estimated $2 billion a year, according to the results of a new Web-based survey.

The study, presented Thursday at the annual American Academy of Orthopedic Surgeons meeting in San Francisco, looked at the toll defensive medicine takes on the specialty.

"Many studies have argued that defensive medicine is a major cost driver in health care; however, the national prevalence of defensive medicine in the field of orthopedic surgery has not been investigated," write the authors of the abstract, listed as Drs. Manish K. Sethi, William Obremskey, Hassan R. Mir and A. A. Jahangi of Nashville, Tenn. and Hazel Natividad of Rosemont, Ill.

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The study examined the answers of 1,214 orthopedic surgeons, randomly chosen from an AAOS registry, who answered a Web-based survey, with cost estimates derived from Centers for Medicare and Medicaid Services data, the authors said.

According to the survey results, 96 percent of respondents said they ordered tests, specialist referrals or hospital admissions in an effort to limit their malpractice liability, with on average 24 percent of imaging tests ordered for purely "defensive" reasons. One-fifth of X-rays, one-quarter of CT scans, and nearly one-third of MR scans were ordered "defensively," according to the abstract.

Using average CMS costs for the procedures, the researchers estimate the monthly price tag of defensive medicine per respondent is about $8,500, or close to $100,000 a year. Extrapolating from these results to the nearly 20,000 orthopedic surgeons working in the United States, the researchers say the costs approach nearly $2 billion annually.

"Defensive medicine among orthopedic surgeons is a significant factor in health care costs and of marginal benefit to patients," the researchers write in conclusion. "Policies aimed at managing liability risk may be useful in containing such practices."

The abstract is "The Prevalence and Costs of Defensive Medicine Among Orthopaedic Surgeons: A National Survey Study."

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