According to an estimate by researchers at Vanderbilt University Medical Center, orthopedic surgeons generate around $2 billion each year in additional health care costs linked to orthopedic care, as a result practicing defensive medicine (ordering additional but unnecessary tests and diagnostic procedures). The study is published in the February issue of the American Journal of Orthopedics.

These additional tests may help clear physicians from accusations of malpractice, even though they result in no considerable benefit to patients’ care.

According to the researchers these unnecessary costs play a significant role in the countries increasing cost of health care.

The researchers findings derive from a national survey of 2,000 orthopedic surgeons, randomly selected through a list provided by the American Academy of Orthopedic Surgeons. Survey respondent practice in a variety of settings and were located in all 50 states. 96% of the 61% of orthopedic surgeons, who responded, reported practicing defensive medicine, which accounts for 24% of all laboratory tests, imaging studies, hospital admissions and consultations among the survey’s cohort.

Manish Sethi, M.D., assistant professor of Orthopedic Surgery and Rehabilitation, and lead researcher of the study, explained:

“Currently, our nation’s expenditure on health care is 20 percent of the GDP [gross domestic product]. This figure really bothers us and served as motivation to conduct this survey. If defensive medicine can be curbed, we will see a dramatic reduction in health care costs, and our research makes this case.”

The survey collected data on the number of medical tests, such as ultrasounds or x-rays, a physician ordered each month. The researchers then looked at how many of these tests were ordered in a defensive manner.

The researchers used the American Medical Association’s CPT (Current Procedural Terminology) billing codes as a reference point for costs. They then worked out the average cost of each imaging test and tabulated an average cost per month.

They discovered that orthopedic surgeons spent on average, $8,484 each month on the practice of defensive medicine, adding up to almost one fourth of their total practice costs. Per survey respondent, the cost for defensive medicine averages $101,820 per year. When multiplied by the 20,400 orthopedic surgeons practicing in the U.S., this figure significantly rises to $2,077,128,000.

Ordering additional procedures or tests is known as positive defensive medicine. In addition, the team analyzed negative defensive medicine – the practice by physicians of avoiding procedures or high-risk patient to reduce liability.

In the past 5 years, 84% of respondents reported to reduce or stop performing high-risk procedures or services, while 70% of respondents reduced the number of high-risk patients they treat.

Write-in examples of defensive medicine include:

  • not operating on individuals suffering with heart problems or diabetes
  • closing a practice to become a consultant
  • and no longer seeing patients in an emergency room

Dr. Alex Jahangir, assistant professor of Orthopedic Surgery and Rehabilitation, and study author, said:

“It becomes an access of care issue. Patients are now losing access to physicians if they happen to be diabetic, obese, or a smoker with heart problems. Their care will be delayed; the costs will increase because they have to be flown to a tertiary center. Negative defensive medicine is a big part of the problem.”

Although Sethi was involved in a similar investigation of orthopedic surgeons in Massachusetts that found similar results, this is the first study to show that defensive medicine practices are prevalent across the country.

According to Sethi and Jahangir, instead of focusing on liability policies reforms should focus more on evidence-based medicine.

Sethi explained:

“We believe an evidence-based approach is the best approach. If we can develop standards of practice that are accepted across the nation, physicians won’t need to order these additional x-rays and MRIs to protect themselves, and we know costs will go down.”

Written by Grace Rattue