Physicians Practicing in Areas with High Malpractice Claims Order More Advanced Imaging

Researchers supported by the Neiman Health Policy Institute (NPHI) find that higher numbers of paid malpractice claims are associated with a subsequent increase in advanced imaging utilization. The Journal of American College of Radiology study examined the quantity and cost of malpractice claims and Medicare imaging utilization at the state and national level. The authors found that each additional paid malpractice claim over the course of five years was associated with an average of 1,389 additional advanced imaging examinations — in the Medicare population alone — in the subsequent year. Advanced imaging was defined as MRI, CT, ultrasound, and nuclear medicine imaging such as PET. Each 1% increase in average paid malpractice claims was associated with a subsequent 0.20% increase in advanced Medicare imaging use. 

“Our study suggest that physicians’ advanced imaging ordering behavior is susceptible to an ongoing climate of regional malpractice litigation. Supporting the notion that physicians living in high-risk malpractice liability regions are more susceptible to employing defensive medicine practices,” stated first author Alexander Villalobos, MD, radiology resident at Emory University School of Medicine.

Since most malpractice cases take place in state courts, Dr. Villalobos and colleagues focused on state-to-state variation in both Medicare imaging usage and paid malpractice claims. The researchers used the National Practitioner Data Bank (NPDB) to identify malpractice claims over the 13-year study.  The authors reported that, after controlling for secular trends, Medicare advanced imaging utilization was positively associated with prior multiyear averages of the number of per capita paid malpractice claims.

The Neiman Institute team found advanced imaging utilization correlates to higher numbers of paid malpractice lawsuits versus the actual dollar amount paid, a consistent finding in studies in other specialty groups. While both the quantity and cost of malpractice claims and Medicare diagnostic imaging utilization have declined nationally, the cost for these two entities remains substantial (over one million dollars for every 100,000 people in the US in the final study year). Villalobos stated, “Policymakers seeking to curb unnecessary healthcare spending should carefully consider the direct and indirect impact of malpractice litigation on physician medical practice behaviors.”