One of the major points raised in the health care reform debate is how tort reform, specifically measures to reduce medical malpractice litigation, can be part of health care reform and contribute to reducing health care costs. President Obama has indicated that he is in favor of tort reform measures. (See DM 11854). The theory of tort reform is that by reducing the likelihood of litigation, health care professionals would not have to practice what is known as "defensive medicine" - measures taken in tests and treatment of patients to avoid a malpractice lawsuit.

Jackson Healthcare LLC of Alpharetta, Ga., (whose companies provide physician and clinician staffing, anesthesia management, hospital management and health care information technology services) has recently released a summary of information garnered from a survey on physicians and defensive medicine practices. Jackson conducted a national survey of physicians in October and December of 2009. Jackson then retained Gallup to conduct an independent national physician poll.

Jackson's summary of the research reports that the Gallup survey found:

-- Physicians estimate 26 percent of overall health care costs go to practicing defensive medicine
-- Seventy-three percent of physicians surveyed indicated they had practiced some form of defensive medicine in the last twelve months
-- The physicians who agreed they had practiced a form of defensive medicine in the last twelve months attributed 21 percent of their practice's activities to defensive measures.

The Jackson Healthcare surveys found:

-- Physicians attributed 34 percent of overall health care costs to defensive medicine
-- Nine out of 10 physicians (92 percent) reported practicing defensive medicine
-- In cases of true negligence, 89 percent of physicians agree that patients receiving negligent treatment should be compensated
-- Emergency room, primary care and OB/GYN physicians are the health care professionals most likely to practice defensive medicine
-- Younger physicians and female physicians reported less tolerance for risk and are more likely to practice defensive medicine
-- Physicians who reported practicing defensive medicine estimated that 35 percent of diagnostic tests, 29 percent of lab tests, 19 percent of hospitalizations, 14 percent of prescriptions and eight percent of surgeries were ordered/performed to avoid litigation

Bob Schlotman, Chief Marketing Officer of Jackson Healthcare, spoke to DOTmed regarding the defensive medicine survey findings.

DOTmed: In presenting the results of the surveys, what points does Jackson hope to get across in the health care debate that legislators should consider?

Mr. Schlotman: "One - Changing the discussion to reducing or eliminating the practice of defensive medicine from just capping malpractice awards; this can potentially save between $650-$850 billion dollars a year as estimated by practicing physicians. Two - We need to change the system, because physicians fear that one mistake could wipe out everything they've worked for. Over 89% of the physicians believe that patients receiving negligent care should be compensated."

DOTmed: What does Jackson feel, from the survey results, is the most costly aspect of defensive medicine to physicians, and to patients?

Mr. Scholtman: "One - That they are personally financially liable for any mistake. Two - Diagnostic tests are the most common form of defensive medicine, representing 35% of the costs."

The Jackson summary notes that the state of Texas passed tort reform legislation in 2001, and that Texas physicians practice somewhat less defensive medicine than average (80 percent in Texas vs. 92 percent in the U.S.). However, Jackson Healthcare chairman and chief executive officer, Richard Jackson feels that traditional tort reform (such as caps to damage awards) is not enough to eliminate the practice of defensive medicine. In an article on the Jackson Healthcare Web site, he suggests comprehensive solutions, including: 1. eliminating personal financial liability for physicians' unintended errors, 2. creation of independent, expert medical review boards to review claims and determine if negligent treatment has occurred and, 3. establishment of separate boards to award consistent, fair compensation to wrongfully-injured patients.

The Jackson Healthcare summary and article can be accessed at: http://www.jacksonhealthcare.com/healthcare-research/healthcare-costs-defensive-medicine-study.aspx
http://www.jacksonhealthcare.com/media/69268/jh%20summary%20sheet%20dm2010a.pdf
http://www.jacksonhealthcare.com/healthcare-research/lawsuit-driven-medicine-healthcare-system.aspx