Malpractice Environment and Cardiology Service Intensity

There is a lot of continuing controversy over whether various malpractice reforms which seek to limit the ability of patients to sue or to collect certain kinds of damages have a meaningful effect on physician behavior and on health spending.  New research carried in the Journal of the American Medical Association Cardiology finds that these limitations are associated with a reduction in utilization and spending for treatment of coronary heart disease.   (JAMA Card. Article)   Coronary heart disease is common, associated with serious illness requiring hospitalizations and other interventions and requires significant physician judgment on how best to diagnose and treat the condition.  The researchers compared the practices of doctors in nine states that adopted damage caps between 2002 and 2005 to the practices of physicians in 20 states which did not adopt caps.  This group of doctors was also compared with doctors in 22 states which had adopted caps prior to 2002.  Changes over time were assessed for all groups using administrative claims data from Medicare.

Rates of use of stress test, angiography, PCI and coronary artery bypass surgery were analyzed.  As usual, the results were adjusted for various socio-demographic and socio-economic factors, as well as health status.  The behavior of over 75,000 physicians was considered.  While the base rates for any kind of ischemic evaluation was relatively stable between doctors in the new cap states versus those in a no-cap state, the type of testing changed dramatically, with the physicians in the new cap states relying more on stress tests and less on angiograms.  This effect grew over time following passage of the cap and reached over 30% less invasive test use.  In addition, the doctors in the new cap states did fewer PCI procedures, although use of CABG surgery stayed similar to that of no-cap state physicians.  It appears that physicians were more likely to be less aggressive in testing and some procedure use when the faced lower malpractice risk and exposure.  Not only did this likely result in lower spending, but it probably created less risk for patients and avoided unnecessary testing and procedures.  Malpractice suits generally only benefit attorneys and continuing to limit them can help with our spending problems.