Dec 10

Time to Rid System of Defensive Medicine

Capitol Stethby Jeff Segal and Wayne Oliver
Originally published in the Las Vegas Review-Journal on December 9, 2015

Last week, Congress sent to President Barack Obama a budget plan that includes language to repeal the Affordable Care Act. With a veto looming over this legislation, all eyes will once again be focused on Obamacare and how it has contributed to skyrocketing health care costs.

According to a new report from the Centers for Medicare and Medicaid Services, per person spending on health care rose to $9,523 per person in 2014. Health care spending rose to 17.5 percent of GDP last year. And the Kaiser Family Foundation this fall released data showing deductibles have increased seven times faster than wages since 2010.

With the GOP contenders for the White House debating Tuesday in Las Vegas, it’s time to address what is ailing so many consumers — these unsustainable costs in health care. While polls show a consensus to repeal and replace the ACA, there has been little discussion about cost containment.

Particularly, we need a serious approach to tackling wasteful medicine that permeates health care and is driving up costs.

Wasteful medicine — known as defensive medicine to physicians — occurs when doctors order more tests, medications and procedures than are clinically and medically necessary. They practice this wasteful, defensive medicine to avoid being sued.

Defensive medicine occurs, for example, when a patient arrives with chest pains in an emergency room. A blood test shows that his enzyme levels are normal and he is not having a heart attack. The physician diagnoses the patient with an anxiety disorder. But because of fear of litigation, the doctor also orders a battery of heart-related tests to protect the doctor from potential litigation.

Defensive medicine will cost consumers an astounding $487 billion nationwide this year, according to BioScience Valuation, a health care economics firm. In comparison, that is about equal to Google’s net capitalization. Defensive medicine costs are then absorbed into higher premiums, co-pays and deductibles.

A survey released earlier this year by the Official Journal of the Congress of Neurological Surgeons found that more than 75 percent of neurosurgeons said they practice defensive medicine to protect themselves from lawsuits. In 2010, Gallup found that one in four health care dollars could be attributed to defensive medicine.

Candidates for president seeking true health care cost containment should consider a proposal, under consideration in five states, to eliminate wasteful, defensive medicine known as the Patients’ Compensation System. Florida, Georgia, Tennessee, Montana and Maine are considering this plan, which would abolish the broken medical malpractice litigation system. It would create an administrative, no-blame model which would be considerably more efficient.

Under a PCS, an injured patient would file a claim before a panel of health care experts instead of filing a lawsuit, which takes years to litigate with uncertain outcomes. If the panel of health care experts determined that a patient suffered a medical injury, the patient would be fairly, appropriately and quickly compensated.

The proposal would also be extremely beneficial to patients, because only the few patients with severe injuries succeed in court and ever earn compensation. A recent research article in the Vanderbilt Law Review said the majority of medical malpractice attorneys said they would not take strong cases unless the payout was at least $500,000. Even if cases were most certainly winners, more than half the attorneys indicated they would not take a case unless they expected damages of $250,000 or greater.

Health care is on its way to becoming the single greatest cost in all of our lives. It is already creating a drag on our economy, because businesses can’t afford to hire, invest or offer significant salary raises to employees. Repealing the ACA won’t do any good unless we go beyond the symptoms and diagnose the true cause of this problem — wasteful, defensive medicine. Abolishing medical malpractice and creating a Patients’ Compensation System would be the best medicine to healing our nation’s health care economy.

— Jeff Segal, a neurosurgeon, is CEO of Medical Justice and a board member of the nonprofit Patients for Fair Compensation. Wayne Oliver is executive director of Patients for Fair Compensation.

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