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For orthopedists, defensive medicine costs $2B annually

Survey finds 96% of orthopedists order unnecessary tests

Topics: Orthopedics, Service Lines, Process Improvement, Management Tools, Performance Improvement, Process Improvement, Efficiency

February 13, 2012

Approximately one-quarter of tests and referrals ordered by orthopedists were medically unnecessary, resulting in more than $2 billion in annual health care costs, according to a recent survey.

For the survey, Vanderbilt University researchers analyzed the responses of 1,241 orthopedic surgeons who are listed in the American Academy of Orthopaedic Surgeons (AAOS) registry. According to the results, about 96% of respondents said they had practiced defensive medicine, including ordering scans, lab tests, and hospital admissions to avoid malpractice suits. On average, 24% of tests were ordered for defensive reasons.

Specifically, the percentage of certain procedures ordered for defensive purposes include:

  • Plain X-rays: 19%
  • CT scans: 26%
  • MRI scans: 31%
  • Ultrasound studies: 44%
  • Subspecialty referrals and consultations: 35%
  • Hospital admissions: 7%

Based on American Medical Association billing codes, the researchers found that orthopedic surgeons spent about $8,500 monthly on defensive medicine—or about $102,000 per physician annually. Overall, orthopedists nationwide spend nearly $2 billion on defensive medicine each year, according to the study.

"Defensive medicine drives up the cost of patient care and limits patient access to specialty care, neither of which are in the interest of our patients who deserve the best and least costly care possible," says AAOS spokesperson Douglas Lundy. "Unfortunately, the current legal climate forces good doctors to order these tests and practice defensive medicine" (Gever, MedPage Today, 2/9; Salamon, HealthDay, 2/9).

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