Tag Archives: defensive medicine

The GOP Plan to Reduce Frivolous Medical Malpractice Lawsuits

Join us on the latest episode of Healthcare Matters as we speak with Representative Phil Roe (R-Tenn) and Representative Andy Barr (R-Ky) about the American Healthcare Reform Act of 2017 (HR 277), a bill they introduced to Congress in January. Their bill would repeal and replace the Affordable Care Act (ACA), President Obama’s signature healthcare law. Unlike the ACA, HR 277 includes provisions to help reform the medical liability system, including a “safe harbor” for physicians who follow clinical practice guidelines. The bill would also move certain types of medical liability cases from state courts to federal court.

Rep. Roe was a practicing OB-Gyn prior to being elected to Congress in 2009 from Tennessee’s 1st District. Rep. Andy Barr, elected in 2013 from Kentucky’s 6th District, is a former trial attorney. Both are members of the Republican Study Committee (RSC), where they worked with current Secretary of Health and Human Services Tom Price, who has also been a proponent of including medical liability reform in Republican efforts to replace the ACA.

Click below to view our full interview with Rep. Roe and Rep. Barr.


 

Fee-for-Service vs. Outcome-Based Models and the Effect on Healthcare Costs

In the final part of Healthcare Matter’s interview with Anupam Jena, MD, PhD, we discuss how the move from the current fee-for-service model to an outcome-based reimbursement model will affect the cost of healthcare in the United States. Dr. Jena explains that he does not think that this change will have as great an effect as is often supposed, as there is already a great deal of variation in spending among doctors. The reasons for this are unclear, but may reflect differences in training and physician risk tolerance.

Finally, we talk about the implications of Dr. Jena’s study for practicing physicians. Dr. Jena explains that physicians should not take his study’s results as an indication to change their behavior, i.e. that they shouldn’t start ordering more tests because of the study. However, the study raises important possibilities, including the idea that extra healthcare spending is not necessarily wasteful, and may, at times, lead to better outcomes for patients as well as the side benefit of physicians being sued less often.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part VII of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

How can we differentiate between defensive medicine and “good” medicine?

In part six of Healthcare Matter’s interview with Anupam Jena, MD, PhD, we discuss with Dr. Jena whether or not it is possible to differentiate between defensive medicine and “good” medicine. He explains that this is difficult to do and was not addressed in the research for the study Physician spending and subsequent risk of malpractice claims: observational study. However, he explains that the question of patient outcomes, which can help to parse out whether additional spending was defensive or not, is something that he is addressing in his current research. Additionally, he states that for individual physicians, the takeaway that more spending results in being sued less often may help physicians to make better decisions on how much care to provide.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part VI of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

Physician Spending, Patient Outcomes and Future Research

In part five of Healthcare Matter’s interview with Anupam Jena, MD, PhD on the study, Physician spending and subsequent risk of malpractice claims: observational study, Dr. Jena explains some of the limitations of the research he conducted. First, the study was not set up to determine if the relationship between physician spending and a lower likelihood of being sued was a cause and effect relationship. Additionally, the study only considered data from Florida and did not delve into the situation in other states. Florida has a unique malpractice environment when compared with many parts of the country, so data from Florida may not be representative of trends in other states or across the nation.

Dr. Jena also addresses the implications of his study regarding lowering healthcare costs. Physicians may have little reason to constrain spending if greater spending levels result in fewer medical malpractice suits. Additionally, in the current fee-for-service model, physician income is directly tied to spending. However, Dr. Jena cautions, there could be unintended consequences to reducing spending, so it is important to monitor these issues.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part V of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

Medical Malpractice Claims and the Doctor-Patient Relationship

Part four of Healthcare Matter’s interview with Anupam Jena, MD, PhD, Dr. Jena addresses the impact of the doctor-patient relationship on medical malpractice suits. Though he states that the idea that patients are less likely to sue a physician with whom they have a good relationship seems to be valid, he goes on to say that there is not very much data on how the quality of the doctor-patient relationship impacts medical malpractice lawsuits. Rather, these questions are ones that researchers are only now attempting to answer.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part IV of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

The Link between Physician Spending and Medical Malpractice Claims

In part three of Healthcare Matter’s interview with Anupam Jena, MD, PhD, we discuss additional findings in his study, Physician spending and subsequent risk of malpractice claims: observational study, including the potential link between physicians spending more and getting sued less often. Dr. Jena speculates on reasons for the link, such as patients who get more care being less likely to sue because the patient feels that all possibilities were exhausted, or the possibility that the greater amount of care actually resulted in a better outcome for the patient and therefore led to fewer lawsuits.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part III of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

Greater Use of Resources vs. Defensive Medicine: What’s the Difference?

In the second part of our Healthcare Matters interview with Dr. Anupam Jena, MD, PhD, we discuss the difference between defensive medicine and greater use of resources. Dr. Jena clarifies that, even if a physician is motivated by liability concerns to order more tests or procedures, it does not necessarily mean that the physician is practicing defensive medicine. Instead, it depends on the result of the additional care. If the result is beneficial to the patient, then it is not defensive medicine – even if the physician was motivated by liability concerns. As Dr. Jena explains, “….the intent of the malpractice system (is) to get physicians to practice appropriately…. To the extent that greater use of healthcare services actually improves patient outcomes, we don’t want to call that defensive medicine.” Instead, defensive medicine includes only additional care that provides no benefit to the patient.

Dr. Jena also delves into the results of his study, describing three major findings. First, according to the study data, physicians who spend more are less likely to get sued. Second, when observing the same physician over time, in years when that physician spent more, he or she was less likely to get sued compared with years in which that same physician spent less. Finally, Dr. Jena discusses the example of C-sections, which are widely thought to be defensively motivated in the United States, as U.S. rates are very high. However, the results of Dr. Jena’s study indicate that physicians who ordered more C-sections were less likely to be sued. Though these results are very intriguing, as Dr. Jena explains, he and his fellow researchers did not look at outcomes, so it is difficult to determine whether these increases in spending were defensive in nature, or actual examples of better care leading to better outcomes and, therefore, a lower rate of lawsuits.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part II of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

Does Defensive Medicine “Work”?

Defensive medicine is a difficult problem to pin down. Though the majority of physicians report practicing defensive medicine when surveyed, it is difficult to determine the true scale of the issue and its influence on the healthcare system. Join us on Healthcare Matters as we sit down with Anupam B. Jena, MD, PhD to discuss the study Physician spending and subsequent risk of malpractice claims: observational study, which was published last November in The BMJ. In the first part of our interview with Dr. Jena, the study’s lead author, he explains that he and his co-authors set out to answer the question of whether or not physicians who ordered more tests and procedures as compared to other physicians were less likely to be sued for medical malpractice.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part I of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


 

The Sate of Defensive Medicine: Full Interview

Richard E. Anderson, MD, FACP, the Chairman and CEO of The Doctors Company, recently sat down with Healthcare Matters for a wide-ranging interview on the topic of defensive medicine. Dr. Anderson has been a thought-leader in the field since publishing the article Billions for Defense: The Pervasive Nature of Defensive Medicine in 1999. During the interview, he addressed topics such as tort reform, alternative dispute resolution systems, the pervasiveness of defensive medicine both in the United States and internationally and a recent research study published in the BMJ on defensive medicine.

Dr. Anderson offered his own definition of defensive medicine, as “A test, procedure, or therapy that is ordered by a physician primarily to protect himself or herself from liability rather than because of its diagnostic or therapeutic utility.” He also spoke on the costs associated with defensive medicine and the difficulties in determining these costs. Above all, our series helps to shed light on why defensive medicine is such a deeply entrenched problem for the healthcare system, as well as some possible ways to combat the situation. See below to watch the entire interview. To see Part I, click here.

 

The State of Defensive Medicine, Part VII: The Medical Liability Insurance Landscape

In the final segment of our interview with Dr. Richard Anderson, Chairman and CEO of The Doctors Company, we ask him if and how the medical liability landscape has changed since he published the article Billions for Defense: The Pervasive Nature of Defensive Medicine in 1999. Dr. Anderson’s response is that the practice of defensive medicine has not changed and, indeed, most physicians in the United States and in many developed countries readily admit to practicing defensive medicine.

With the practice of defensive medicine being so pervasive both in the United States and overseas, Dr. Anderson goes on to state his belief that a cultural change will be necessary to transform the situation, as only a cultural change will make patients who experience an adverse medical outcome less likely to sue. Without such a profound shift, it will be difficult to solve the problem of defensive medicine. Watch the final part of our video series below. To see the entire interview from the beginning, click here.