Physicians are using medical imaging as a defense against malpractice claims, study finds

U.S physicians are, in fact, ordering medical imaging as a defense against malpractice claims, according to a new analysis released on Wednesday.

Studying national Medicare imaging trends over a 12-year period and lining them up against lawsuit payouts, experts from Emory University found a correlation. In particular, states with a high-risk level of litigation were positively associated with utilization of advanced imaging, researchers wrote Aug. 19 in JACR.

“Although causality cannot be asserted from our observational study, positive associations between paid malpractice litigation and subsequent advanced Medicare imaging utilization support the notion that U.S. physicians use medical imaging as a defensive medicine strategy,” concluded Alexander Villalobos, MD, with the Department of Radiology and Imaging Sciences at the Atlanta institution, and coauthors in health policy and economics. “Policymakers seeking to curb unnecessary healthcare spending should carefully consider the direct and indirect impacts of medical malpractice litigation on physician practice behaviors.”

The United States spends more per capita on care than any other country in the world, the authors noted. And that’s been partly attributed to high rates of imaging use as defense against litigation. Medical liability in the states consumes an astounding $64 billion in a single year alone, Villalobos et al. wrote.

To better understand these trends, his team analyzed a 5% sample of Medicare claims logged between 2004-2016, keying in on state population-adjusted rates of imaging. They then matched those up against paid physician malpractice claims from the National Practitioner Data Bank to look for any parallels.

Emory investigators determined that—when controlling for several factors—that advanced imaging use was positively associated with the lagged number of per capita paid malpractice claims. For every 1% average increase in such payouts, there was a subsequent 0.2% uptick in advanced imaging utilization. All told, Medicare imaging spending and use dropped 31.4% and 47.2%, respectively, during the study period. And at the same time, paid malpractice claims and amounts plummeted 46.4% and 39.6%, the team concluded.

You can read much more of the analysis—including state-level spending and malpractice payouts—in the Journal of the American College of Radiology here.