Author + information
- Steven A. Farmer,
- Ali Moghtaderi,
- Bernard Black,
- David Magid,
- Frederick Masoudi,
- Norrina Allen,
- Samantha Schilsky,
- Avi Dor and
- William Sage
Background: Physicians often report practicing “defensive medicine,” including ordering marginally beneficial tests and interventions to reduce their malpractice liability risk. Yet, most economic studies find no decrease in spending after malpractice reform.
Methods: This study uses a random 5% sample of Medicare administrative claims to examine testing and intervention decisions for coronary artery disease. We use a difference-in-differences research design to compare 9 states that adopted caps on non-economic damages over 2002-2005 to 20 states without damage caps. All models use physician and time fixed effects, and extensive patient, county and state-level health, demographic, economic, and market control variables.
Results: There was no significant change in ischemic evaluation rates (stress test or left heart catheterization, LHC) after tort reform (+0.42%; CI [95 % Confidence Interval] -8.28, 9.12; p=0.92). Stress testing increased (+ 8.45%; CI −3.1, 20.06; p=0.15) but this was offset by lower rates for LHC as a first diagnostic test (- 17.65%; CI −36.1, -6.3; p=< 0.01). There was a significant decrease in progression from ischemic evaluation to revascularization (-27.81%; CI -48.60, -7.02; p=0.01). Patients with an initial stress test were also less likely to proceed to LHC (-26.53%; CI -48.64, -4.28; p=0.02), and patients who completed a LHC were somewhat less likely to be revascularized (-9.44 %; CI -26.76, 7.87; p=0.27).
Conclusions: Physicians changed their testing and intervention practices in response to adoption of damage caps. The overall rate of testing for coronary artery disease did not change, but physicians shifted to less invasive testing (stress test instead of LHC) and revascularization rates fell. These findings suggest that physicians are willing tolerate greater clinical uncertainty if they face lower malpractice risk.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-323
- 2017 American College of Cardiology Foundation