Thursday, July 19, 2012

Business Analysis / Current Event - Defensive Medicine: A Culprit in Spiking Healthcare Costs


Business Analysis - Current Event
Defensive Medicine: A Culprit in Spiking Healthcare Costs

Author: Jeffrey Segal

Healthcare costs are increasing in the healthcare industry today due to the fact that many physicians are ordering a number of unnecessary tests and procedures for their patients. Defensive medicine occurs when physicians order unnecessary tests and procedures to reduce them from being exposed to a malpractice lawsuit; this is considered to be a positive defensive medicine. When the physician refuses to treat a patient or perform a certain procedure, this is considered to be a negative defensive medicine.

 In the Medical Economics article entitled, “Defensive Medicine: A Culprit in Spiking Healthcare Costs” author Jeffrey Segal discuss how physicians order tests and procedures on a daily basis that are not medically necessary, including the implications of defensive medicine. These tests include magnetic resonance imaging (MRI), computed tomography (CT) scans, electrocardiograms (EKG), stress tests and biopsies, just to name a few.  In 2010 the Gallop organization conducted a poll and found that “about $1 in every $4 spent in healthcare can be attributed to tests and procedures that are clinically unnecessary” (Para. 2).

According to author, Paul A. Manner M.D., “calls for tort reform hold that the practice of defensive medicine is a major factor increasing the cost of medical care. Although the concept of defensive medicine seems obvious, a true estimate of its cost and impact is surprisingly hard to find.”

It is believed that in order for the physician’s behavior to change, the medical tort system must take the lead in changing the awareness about defensive medicine.  Many physicians feel they have no other choice but to order these particular tests to keep them out of lawsuits for unnecessary reasons. There have been many cases where physicians have ordered tests, “in most cases, physicians order up tests not because they were necessary to diagnose what was wrong, but because if they didn’t and something went very wrong, they believe they would not be protected in a lawsuit” (Par. 4).
A nonprofit organization, Patients for Fair Compensation estimated a cost of about $650 billion a year from tests that were not necessarily needed. This $650 billion a year includes money coming out of the taxpayers’ pockets.  Medicare is known to pay $125 million a year and Medicaid pays up to $96 for unneeded tests and procedures. There is a list of certain test and procedures such as CT scans for fainting episodes, stress tests, and chest x-rays for routine outpatient surgeries to name a few that patients can do without.  The physicians feel obligated to order these tests and procedures because patients request them so often. These patients are people who want their diagnosis quickly and if the test is the way then that is what they push the physicians to do. In other words, it's a never-ending cycle that will not end anytime soon as long as physicians feel like potential targets in a lawsuit. The only solution would be to revamp our nation's medical tort system. "States such as Florida and Georgia are considering a move to an administrative, non- adversarial model, proposed by Patients for Fair Compensation, called the Patient Compensation System" (Para 10).  Patients in these states can take their complaints and claims to a panel board that is similar to workers' compensation and their cases would be heard in months rather than years. This system would keep physicians from being dragged in and out of the courts for lawsuits because they would not be held accountable for any tort claims. I believe this is the start to raise awareness about defensive medicine but also know that the legal system must change first to jump-start this ordeal.
Sources:
 http://go.galegroup.com/ps/i.do?id=GALE%7CA294194095&v=2.1&u=txshracd2589&it=r&p=HRCA&sw=w

Segal, Jeffrey. “Defensive Medicine: A Culprit in Spiking Healthcare Costs.” Medical Economics 25 May 2012: 70 + Health Reference Center Academic. Web 11 July 2012.
http://www.aaos.org/news/bulletin/janfeb07/clincial 2.asp














1 comment:

  1. I would have to disagree in my opinion I do not believe that our health care costs are rising due to physician ordering unnecessary tests. I do believe that sometimes it takes more than just one test to find what could be wrong with a person. My point of view on medical is that I would hate to be the person sick and just have a physician say this is what is wrong but I dont want to run too many tests just incase I am right and then it looks like I did unnecessary testing.

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