“Defensive Medicine?” How About Docs Lining Their Pockets?

There’s a blockbuster report by Shankar Vedantam in today’s Washington Post that’s a must-read for anyone whose reached their saturation point with so-called “defensive medicine” myths.

The Post got its hands on some Wellmark Blue Cross and Blue Shield documents, and what they found was pretty damning.  Bottom line: some docs are prescribing expensive, unnecessary, and sometimes even dangerous tests—not to insulate themselves from lawsuits (as the “defensive medicine” myth goes)—but to line their own pockets (i.e., “offensive medicine!”).

Now in all honesty, this isn’t exactly the “newest” of news.  The Congressional Budget Office found in 2004 that “[S]ome so-called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians…”.  And even more recently, an influential report in the New Yorker
captured this telling passage involving an exchange between two McAllen, TX doctors:

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down? “Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bull---t. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

Well, suffice it to say today’s Post article advances the “offensive medicine” argument even further.  It found, for example, that in 2005, doctors at a medical clinic on the Iowa-Illinois border were ordering eight or nine CT scans a month in August and September of 2005.  But after those doctors bought their own CT scanner, within seven months, those numbers ballooned by 700 percent.

The Post did a similar analysis of the Wellmark data for doctors in the region and found that after CT scanners were purchased, the number of scans they ordered was triple that of other area doctors who hadn’t purchased such equipment.  The Post also cited consistent data from the GAO and MedPac. 

Dr. Stephen J. Siegel told the Post, “Just because doctors have CT scanners in their office does not mean they are abusing the system.”  Fair enough. 

But as Jean M. Mitchell, a professor for public policy and a health economist at Georgetown University suggested, getting rid of this sort of “offensive” profit-driven medicine “could reduce the nation’s health care bill by as much as a quarter.”

Needless to say, that estimate dwarfs the less than one percent of health care costs represented by insurance payments to injured consumers who file claims (that are supposedly scaring so many doctors into ordering unnecessary tests).  Just an observation…

Comments

[Andrew J. Barovick]

Thanks for helping to expose this cynical ploy that has been successsful for too long for tort "reformers." It is this same, base greed that explains why more docs refuse to work on salary, preferring that land of almost limitless income opportunity, fee-based medical services, where they can practice "defensive" medicine, rake in the bucks, and appear to be pious by claiming that all the extra procedures are necessitated by those evil trial lawyers.