In the coming weeks, the House of Representatives is expected to pass legislation that could comprehensively reform the nation's controversial medical liability tort system. The legislation, named the HEALTH act, aims to reduce overall health care spending by cutting outsize and frivolous medical malpractice lawsuits, thereby reducing high medical malpractice premiums for physicians and ultimately their propensity to practice "defensive medicine." With recent physician surveys indicating that a large proportion of imaging exams might be ordered for defensive reasons, malpractice reform could potentially significantly impact hospital volumes.
The HEALTH Act and Medical Liability Reform
According to a study presented last week at the annual meeting of the American Academy of Orthopaedic Surgeons, imaging exams ordered for defensive purposes account for over 35% percent of total imaging costs associated with orthopaedic surgeons in Pennsylvania. Though previous studies of defensive medicine have surveyed the incidence of defensive imaging amongst various specialties, researchers have traditionally struggled to link its incidence with its total costs.
Study Finds High Cost of Defensive Imaging Amongst Orthopaedic Physicians in Pennsylvania
In recent years, imaging for lower back pain has emerged as a poster-child for inappropriate utilization. Now, the American College of Physicians has taken a definitive and well-articulated position advocating against the use of imaging as the standard approach to addressing lower back pain. A recent article in Annals of Internal Medicine provides a meta-analysis of recent articles on the clinical efficacy of x-ray, CT and MRI scans as a routine approach to evaluating lower back pain and concluded that not only does the practice fail to improve clinical outcomes, it drives up the cost of health care and exposes patients to a variety of avoidable detriments. The article concludes that imaging for lower back pain should be limited to patients with specific risk factors for a small number of serious underlying conditions, rather than deployed broadly as a diagnostic strategy.
ACP Takes a Stand Against Imaging for Low Back Pain