Clinical question: What percent of inpatient health care spending by hospitalists can be attributed to defensive medicine?
Background: Defensive medicine contributes an estimated $45 billion to annual U.S. health care expenditures. The prevalence of defensive medicine among hospitalists is unknown.
Study design: Survey of U.S.-based hospitalists.
Setting: National survey sent to 1,753 hospitalists from all 50 states identified through the Society of Hospital Medicine database of members and meeting attendees.
Synopsis: The survey contained two primary topics: an estimation of defensive spending and liability history. The hospitalists, who had an average of 11 years in practice, completed 1,020 surveys. Participants estimated that defensive medicine accounted for 37.5% of all health care costs. Decreased estimate rates were seen among VA hospitalists (5.5% less), male respondents (36.4% vs. 39.4% for female), non-Hispanic white respondents (32.5% vs. 44.7% for other) and having more years in practice (decrease of 3% for every 10 years in practice). One in four respondents reported being sued at least once, with higher risk seen in those with greater years in practice. There was no association between liability experience and perception of defensive medicine spending. Differences between academic and community settings were not addressed. Because only 30% of practicing hospitalists are members of SHM, it may be difficult to generalize these findings.
Bottom line: Hospitalists perceive that defensive medicine is a major contributor to inpatient health care expenditures.
Citation: Saint S et al. Perception of resources spent on defensive medicine and history of being sued among hospitalists: Results from a national survey. J Hosp Med. 2017 Aug 23..
Dr. Lublin is a hospitalist at the University of Colorado School of Medicine.