Defensive Medicine Strategy Makes Sense in Telemedicine
According to published results, physicians living in regions with a high incidence of medical malpractice claims may be more susceptible to ordering advanced Medicare imaging as a defensive medicine strategy. According to the study, Dr. Alexander Villalobos, and colleagues from Emory University School of Medicine used National Practitioner Data Bank files to calculate paid claim frequencies and payout amounts. “Each additional paid malpractice claim over the course of 5 years) thereby contributing to an unfavorable malpractice litigation environment) was associated with an average of 1,389 additional advanced imaging examinations in the Medicare population alone in the subsequent year.”
Nationwide Medicare imaging utilizations declined by 31.4% and overall spending declined by 47.2%, during the sample period. Also, during that same period, paid medical malpractice claims declined by 46.4% and payout amounts decreased by 39.6%, per 100,000 people. Villalobos and colleagues found a positive association between Medicare imaging utilization and the lagged number of pain malpractice claims per capita. “Each additional paid malpractice claim over the course of 5 years (thereby contributing to an unfavorable malpractice litigation environment) was associated with an average of 1,389 additional advanced imaging examinations in the Medicare population alone in the subsequent year”, Villalobos and colleagues wrote in the study.
It is important to have objective data prior to surgery. Most insurers do not accept clinical exams to confirm a diagnosis. Inexpensive MRIs are going to be the standard of care, as telemedicine becomes more common so the orthopedic surgeon can make a diagnosis with certainty while remote and without examining the patient. A reasonably priced MRI is going to potentially reduce the care costs for patients as opposed to sending the patient for several PT sessions. If cost-effective MRIs are available, the “case costs” will dramatically decrease.