Malpractice Reform Did Not Change ER Doctor Habits or ER Costs

Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaMedicalResearch.com Interview with:
Daniel A. Waxman, MD, PhD
Department of Emergency Medicine
David Geffen School of Medicine
University of California, Los Angeles
RAND Corporation Santa Monica, California

Medical Research: What are the main findings of the study?

Dr. Waxman: About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care.   The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians.  To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws.   We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit.

Medical Research
: What was most surprising about the results?

Dr. Waxman: Our results run counter to conventional wisdom.  We found that even when the risk of being sued for malpractice declined substantially, there was no change in the way that doctors practiced.

Medical Research: What should clinicians and patients take away from your report?

Dr. Waxman: Even though physicians themselves believe that they practice defensively, the evidence suggests that the story is more complicated.  When you take away the threat of lawsuits, the path of least resistance still seems to favor expensive care.

Medical Research: What recommendations do you have for future research as a result of this study? 

Dr. Waxman: One could do further research to determine whether our findings hold up for other specialties.  But the real message here is that if you are looking for ways to reduce unnecessary health care spending, you should probably look elsewhere.   Passing malpractice reform legislation is unlikely to have much effect on the way that doctors practice.

Citation:

The Effect of Malpractice Reform on Emergency Department Care

Daniel A. Waxman, M.D., Ph.D., Michael D. Greenberg, J.D., Ph.D., M. Susan Ridgely, J.D., Arthur L. Kellermann, M.D., M.P.H., and Paul Heaton, Ph.D.

N Engl J Med 2014; 371:1518-1525
October 16, 2014DOI: 10.1056/NEJMsa1313308