Concerns about malpractice suits influence how often cardiologists order some potentially unnecessary tests — resulting in significant variations in healthcare use and spending across the United States, according to research reported in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.
According to the study, only fear of malpractice was associated with differences in the level of healthcare services used within specific geographical regions, although malpractice and peer pressure factors were both significantly associated with doctors' likelihood to aggressively test and treat heart patients,.
"In an era of escalating healthcare costs and focus on the delivery of high-quality care at the lowest possible cost, it is critical to understand why some regions experience so much higher rates of healthcare utilization than others," said F. Lee Lucas, Ph.D., lead author of the study and associate director of the Center for Outcomes Research and Evaluation at Maine Medical Center in Portland.
Researchers focused on cardiac catheterization in the study as a representative measurement of the intensity of heart-related services offered by physicians. (Cardiac catheterization allows doctors to examine blood flow to the heart and how well the heart is pumping.)
When asked about circumstances under which they order cardiac catheterization "for other than purely clinical reasons," nearly 24 percent of the 598 cardiologists surveyed said they recommended the procedure out of fear of malpractice claims.
The survey also showed more than 27 percent of doctors reported ordering cardiac catheterization because of perceived peer pressure, calling for the procedure if they thought another colleague would do so.
The doctors were also given hypothetical patient vignettes and assigned a Cardiac Intensity Score based on their self-reported recommendations for high-tech or invasive tests and treatments. Cardiac Intensity Scores generally corresponded with the degree of healthcare services used within the physicians' respective regions.
Researchers evaluated region-specific healthcare utilization in 306 Hospital Referral Regions, using two Medicare population based factors – one was specific to cardiac catheterization rates and the other depended on overall healthcare spending among Medicare beneficiaries.
The study suggests that malpractice concerns may be a target for intervention to reduce regional variations.
Greater use of healthcare services doesn't necessarily result in better outcomes or better patient satisfaction, Lucas said.
The study was funded in part by the National Institute on Aging. Co-authors were: Brenda E. Sirovich, M.D., M.S.; Patricia M. Gallagher, Ph.D.; Andrea E. Siewers, M.P.H.; and David E. Wennberg, M.D., M.P.H.