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Associations Over Time Between Paid Medical Malpractice Claims and Imaging Utilization in the United States
Alexander Villalobos1, Michal Horný2, Danny R Hughes3
1Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
Purpose:
The aim of this study was to explore state-level relationships between the incidence and payout amounts for medical malpractice claims and Medicare imaging utilization and spending across the United States.
Methods:
Using claims data from a 5% sample of Medicare beneficiaries for 2004 to 2016, annual state population-adjusted rates of imaging utilization and spending were calculated. Using National Practitioner Data Bank files, all paid physician malpractice claims were identified, and lagged state population-adjusted rolling averages of paid claim frequencies and payout amounts were calculated. Controlling for secular trends and state fixed effects with robust standard errors clustered at the state level to account for serial autocorrelation, associations between imaging utilization and lagged paid malpractice claims were assessed using multivariate regression models. Log-log model specification was used to obtain elasticity measures.
Results:
Between 2004 and 2016, national Medicare diagnostic imaging utilization and spending declined by 31.4% and 47.2%, respectively (from 355,057 to 243,517 examinations and from $28,591,146 to $15,099,291 per 100,000 beneficiaries). Overall national paid malpractice claims and payout amounts declined by 46.4% and 39.6%, respectively (from 4.83 to 2.59 claims and from $1,803,565 to $1,089,112 per 100,000 population). After controlling for secular trends and state fixed effects, advanced imaging utilization was positively associated with the lagged number of per capita paid malpractice claims. Each 1% increase in average paid malpractice claims was associated with a subsequent 0.20% increase in advanced imaging utilization (P = .001).
Conclusions:
Positive associations between paid malpractice claims and advanced Medicare imaging utilization support the contention that US physicians use medical imaging as a defensive medicine strategy.
Insights
Physicians may use advanced medical imaging as a defensive medicine strategy, as increased malpractice claims correlate with higher imaging use. This study found a 1% rise in paid malpractice claims was linked to a 0.20% increase in advanced imaging utilization.
Area of Science:
- Health Economics
- Medical Malpractice
- Health Services Research
Background:
- Medical malpractice claims and Medicare imaging utilization are significant healthcare cost drivers.
- Understanding the relationship between malpractice and diagnostic imaging is crucial for healthcare policy and practice.
- Previous research has explored defensive medicine, but state-level associations with Medicare imaging require further investigation.
Purpose of the Study:
- To examine the relationship between state-level medical malpractice claims (incidence and payouts) and Medicare imaging utilization and spending.
- To determine if physicians' use of advanced medical imaging is influenced by malpractice risk.
- To provide data-driven insights into defensive medicine practices in the US.
Main Methods:
- Analysis of a 5% sample of Medicare beneficiary claims from 2004-2016 for imaging utilization and spending.
- Utilized National Practitioner Data Bank files to identify paid physician malpractice claims.
- Employed multivariate regression models controlling for secular trends and state fixed effects to assess associations between imaging and lagged malpractice claims.
Main Results:
- National Medicare diagnostic imaging utilization and spending decreased between 2004 and 2016.
- Paid malpractice claims and payout amounts also declined nationally during the study period.
- A positive association was found between advanced imaging utilization and lagged paid malpractice claims; a 1% increase in claims correlated with a 0.20% rise in advanced imaging use.
Conclusions:
- The study supports the hypothesis that US physicians utilize advanced medical imaging as a defensive medicine strategy.
- Findings suggest a link between malpractice litigation environment and diagnostic imaging practices.
- Further research can explore the economic and clinical implications of defensive medicine on healthcare delivery.
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