Posted on 07/24/2018 2:36:19 PM PDT by spintreebob
We estimate the extent of defensive medicine by physicians, embracing the no-liability counterfactual made possible by the structure of liability rules in the Military Heath System. Active-duty patients seeking treatment from military facilities cannot sue for harms resulting from negligent care, while protections are provided to dependents treated at military facilities and to all patients—active-duty or not—that receive care from civilian facilities. Drawing on this variation and exploiting exogenous shocks to care location choices stemming from base-hospital closures, we find suggestive evidence that liability immunity reduces inpatient spending with no measurable negative effect on patient outcomes.
(Excerpt) Read more at nber.org ...
https://www.nytimes.com/2018/07/23/upshot/malpractice-lawsuits-medical-costs.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health®ion=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=sectionfront
Gosh gee.. suppose it helps that the majority of the study patients are younger than 30? This is precisely why science has lost its credibility, peddling pharmaceuticals.
I have not had a flu shot for decades.. and I have not had the flu either. This Mengele experimentation has got to stop. There are a handful of vaccines I am all for.
I read the summary differently. I understood it to be saying that when the military is paying, and therefore there is no malpractice exposure, the costs are much cheaper, but there is little difference in outcome. And therefore all the extra things that private doctors do to avoid liability lawsuits do not significantly improve outcome and only raises costs.
Military medicine is not-for-profit while civilian medicine is profit driven. So is it really the fear of liability driving all the tests? Or the money that doctors make by prescribing them?
Doctors make no money from ordering an extra test. They may save themselves boat loads of time that would be spent in deposition, trial, negotiations should a missed diagnosis be litigated.
There is also a study that shows a slight mortality benefit to defensive medicine. But from a public health perspective how do you charge extra on Insurance for everybody to save a small number of people?
Doctors and Hospitals do many unnecessary things. The question is why?
Option #1. Defensive Medicine.
Option #2. Maximize billing opportunity with add ons and upcharges.
When we go into a store for that cheap item, the store tries to get us to buy the bigger, more costly, higher profit margin. The store tries to get us to buy additional things that we never came in to buy.
The same is true of Doctors and Hospitals. I’ll use myself as an example because I’m forbidden to use others. I went into Emory St Joseph in Atlanta with pneumonia. They held me in the emergency room as long as Medicare would allow, and added on as many exams as Medicare would allow.
Then they moved me to Observation, which is purgatory between ER and inpatient. They again did as many procedures as Medicare would allow. Then I went to inpatient.
The anti-biotic they gave me for minor pneumonia cured me in hours. I did not need to go inpatient.
But they gave me an unnecessary xray that Medicare would pay. xray is useless for pneumonia, but required before they can do a CTscan. So the next step was a CTscan. This was totally unnecessary as it was obvious I had pneumonia.
The CTscan found a millimeter black spot on the lung that did not have pneumonia. I knew exactly what it was. I had many dirty jobs and have dirt in the bottom of my lungs. But the doctors didn’t want to hear my explanation.
They wanted to see if it was cancer. That was defensive medicine? So they gave me an enhanced CTscan. That CTscan can’t tell them anything about cancer. But it is billable to Medicare. And Medicare requires it before they can do surgery.
So the next step was a surgical biopsy. It turned out the little black spot was not cancer.
But the biopsy, the little hole, collapsed my lung. So I was in the hospital a week for a collapsed lung.
My first inpatient day, a string of doctors stuck their head in the doorway and said:
You have shingles
You have difficulty breathing (not until my lung collapsed)
You have this. You have that.
Not a single one came within 5 feet of me. They did not examine me in any sense of the word. I do not know if they looked at my charts where the nursing staff recorded my vitals.
Everything they did was billable to Medicare and Medicare paid.
My conclusion from both my personal experience, and the experience in my work is that both defensive medicine and gullibility of Medicare reinforce each other.
Here in GA some hospitals are failing. Some hospitals and their doctors know how to game the system. Some hospitals, either due to ethics or incompetence, do not maximize their billables.
Most large practices perform the blood work, the x-rays, have partnerships with the labs that do the CAT scans. Don't tell me they make no money off the tests.
Medical personal who administer negligent care to military members can find themselves making big rocks into little rocks in Leavenworth.
Think that might have some sort of motivation in making sure you give them top notch care?
So based on this study, we should offer doctors complete immunity from lawsuits, correct?
A negotiated price to save their patients some money is not making any money for the Doctor. If you believe the practice is getting a kickback then I suggest you call CMS. You can probably get a cash payment for exposing the backend payments under the medicare whistleblower program.
Are there doctors and hospitals that are trying to work a scam. There probably are, but medicare has computer programs that run through all the payments out to these doctors because they are practicing beyond the average of the rest of the doctors in the program. So in our computer age the kinds of cheating you are talking about is difficult to do for long.
But many are just responding to perceived litigation risks. What's a $1200 CT scan if it may save a doctor a lawsuit? I don't think the malpractice lawyer's retainer is that low. Not to mention that a doctor has to list every malpractice case ever brought when he goes looking for a job which may mean if you have too many litigations you are going to be limited in what jobs you can obtain. Hospitals would rather take an unproven fresh out newbie with no litigation to an experienced Doctor with 4-5 settled cases with no admission of malpractice.
CMS also publishes a list of the groups that receive the most claims from medicare. You can certainly see if your Doctors group is one of the high rollers in the medicare program.
If you have private insurance many times you will be denied access to further labs and imaging. A nurse or doctor working for the insurance company will review the medical chart and deny the extra labs or imaging. The great thing there is if you don't fight them and you had an undiscovered cancer, you have no legal recourse against your insurance company or the administrative doctor/nurse that denied your tests.
Doctors botched the biopsy and my lung collapsed due to their mistakes. Medicare paid.
If your car mechanic or home repair guy botches a job, do you pay him? Does your home owners or car insurance pay for a botched job?
Take the cash flow and profit out of errors due to inattention and carelessness. Then they will occur much less often, people’s health will improve, and total cost of medical care will go down.
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