"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, October 30, 2011

Does "Defensive Medicine" Drive Up Health Care Costs?


Not according to this report from PublicCitizen.org, A Failed Experiment: Health Care in Texas Has Worsened Since Medical Liability Caps in 2003.
"Those who blame medical malpractice litigation for rising health care costs and diminished access to care tend to focus on the theory that the fear of litigation motivates doctors to prescribe unnecessary tests and procedures to insulate themselves against potential lawsuits.
This is the crux of the defensive medicine argument.
Because Medicare Part B spending is sensitive to the volume of services, a jurisdiction experiencing a dramatic decrease in litigation should realize a decline in the rate of growth in Medicare Part B spending—or even an outright decline in such spending—if the defensive medicine argument is accurate.
According to the theory, the reduced litigation should have reduced doctors’ fear of being sued, which in turn should have reduced the number of tests and procedures doctors prescribed."
Here's the key data:
  • Medicare spending in Texas has risen far faster than the national average. Per enrollee spending for Medicare’s two main programs ranked second-highest in Texas among the 50 states in 2009. In 2003, Texas ranked seventh. In light of the steep reduction in litigation that has occurred in Texas since 2003, these figures contradict the theory that medical malpractice litigation is driving health care costs.
  • Medicare spending specifically for outpatient services in Texas has risen even more steeply compared to national averages.
  • Premiums for private health insurance in Texas have risen faster than the national average.
  • The percentage of Texans who lack health insurance has risen, solidifying the state’s dubious distinction of having the highest uninsured rate in the country.
  • The per capita increase in the number of doctors practicing in Texas has been far slower than in the preceding years.
  • The per capita number of primary care physicians practicing in Texas has remained flat, compared to a sharp increase in the years leading up to the caps.
  • The slope of the red line shows a 24% increase in physicians in rural areas, the green line shows a 1% DECREASE.

  • The prevalence of physicians in non-metropolitan areas has declined.

Why Should Physical Therapists Care About Defensive Medicine?
To the extent that physical therapists are leaders in reforming health care, we should resist "band aid" explanations and "simple" solutions about how to "fix" health care.

Medical liability reform will not "fix" defensive medicine, as the Texas experiment proves.

Real solutions to systemic problems of cost inflation and patient access will require a willingness to examine flawed assumptions that form the foundation of our medical care delivery network.

The main assumption we should examine is the idea that the existing medical hierarchy that puts physicians and other autonomous practitioners at the "sharp end" of health care is tenable and sustainable.

We blame errors and accidents on one individual instead of trying to design better systems that can anticipate and prevent errors in the first place.

How should we make a better system? What role should physical therapists play in the reformed health care system? We welcome your comments.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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