As reported by the Sun Chronicle, November 18, 2008.

Doctors Play Defense with Medical Tests

By Rick Foster

Extra medical tests, hospitalizations and procedures ordered by doctors because they fear being sued is costing billions of dollars each year, says a new survey by the state's leading medical association.

The Massachusetts Medical Society, in a newly released survey of physicians, estimated that so called "defensive medicine" is adding an extra $1.4 billion a year to Bay State patients' medical costs.

The medical society is headed by Sturdy Memorial Hospital's Dr. Bruce Auerbach.

The Investigation of Defensive Medicine in Massachusetts is the first study to track defensive medical practices across a number of specialties. The study is also the first of its kind to link such data directly with Medicare cost data.

The survey queried physicians in eight specialties between November 2007 and April 2008 in anesthesiology, emergency medicine, family medicine, internal medicine, general surgery, neurosurgery, orthopedics, and obstetrics/gynecology. Lead researchers were Dr. Manish K. Sethi, of the Department of Orthopedic Surgery of Massachusetts General Hospital and a member of the medical society's board of trustees and its committee on professional liability, and Robert H. Aseltine, of the Institute for Public Health Research at the University of Connecticut Health Center in Farmington.

The results were released last week to physicians at the medical society's 2008 interim meeting of its House of Delegates in Waltham.

"This survey clearly shows that the fear of medical liability is a serious burden on health care," Sethi said. "The fear of being sued is driving physicians to defensive medicine and dramatically increasing health care costs. This poses a critical issue, as soaring costs are the biggest threat to the success of Massachusetts health reform efforts."

Doctors said the findings could lend credibility to movements for medical malpractice reform.

"Hopefully, given the results of the study and given the state's focus on cost containment, we can get some traction in getting some reform of our tort system in the direction of safety, transparency and appropriate compensation for actual costs," said Sturdy's Auerbach.

Given the extent of defensive medicine costs, Auerbach said reforms could also help rein in skyrocketing health care expenses in general.

In the survey, physicians were asked about their use of seven tests and procedures: plain film X-rays, CT Scans, Magnetic Resonance Imaging (MRIs), ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions. The results were self-reported by the physicians responding to the survey.

The results showed that 83 percent of the physicians surveyed reported practicing defensive medicine and that an average of 18 percent to 28 percent of tests, procedures, referrals and consultations and 13 percent of hospitalizations were ordered for defensive reasons.

Sethi and Aseltine estimated the costs of the tests to be $281 million for the eight specialties surveyed, based on Medicare reimbursements rates in Massachusetts for 2005-2006.

In addition, the cost of unnecessary hospital admissions was estimated to be $1.1 billion, for a combined total estimate of almost $1.4 billion. The estimates do not include tests and diagnostic procedures ordered by physicians in other specialties, observation admissions to hospitals, specialty referrals and consultations, or unnecessary prescriptions.

The eight specialties represented in the survey account for only 46 percent of the physicians in the state.

Medical society officials said defensive medical practices are an outgrowth of high liability risk for the state's doctors. Besides raising medical costs, the study found that liability fears are also reducing the public's access to certain medical treatments as doctors minimize exposure to potentially risky procedures.