The first national survey of orthopedic surgeons revealed that 96 percent have practiced defensive medicine, according to a study presented Feb. 9 at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in San Francisco. The study estimated the annual cost of defensive orthopedic care at $2 billion. Although radiologists and imaging informatics systems play a role in curbing defensive medicine, the issue is broader and requires a comprehensive approach, according to researchers.

In September 2010, researchers asked 2,000 randomly selected orthopedic surgeons to complete a web-based survey on defensive medicine. Of the 1,214 respondents, 96 percent responded that they had ordered imaging or laboratory tests, referred patients to specialists or approved hospital admissions primarily to avoid possible malpractice liability.

Specifically, the survey revealed that 24 percent of imaging exams were ordered for defensive reasons:19 percent of radiography tests, 26 percent of CT scans, 31 percent of MR studies and 44 percent of ultrasounds. Participating orthopedic surgeons also acknowledged that defensive medicine was the motivation behind 35 percent of specialist referrals, 23 percent of laboratory tests and 18 percent of biopsies. Defensive hospital admissions averaged 7 percent each month.

Using the average national Medicare payment information from the 2011 Current Procedural Terminology code reimbursement data, the cost of defensive medicine per orthopedic surgeon respondent was approximately $8,500 per month or $100,000 per year, representing 24 percent of a physician’s annual spending.

Given the U.S. Department of Labor’s statistic of 20,400 practicing orthopedic surgeons in the U.S., investigators estimated the national cost of defensive medicine for the specialty of orthopedic surgery at $173 million per month or $2 billion each year.

The study results show that physicians “are clearly concerned about malpractice issues, and they’re adjusting their practice procedures based on that fear,” Manish K. Sethi, MD, co-director of the Vanderbilt Orthopaedic Institute Center for Health Policy, said in a statement. Eliminating defensive medicine is “an easy thing we can do to lower costs.”

Radiologists, along with other physicians, play a key role. Radiologists can work with other physicians, the government and other organizations to develop clinical practice guidelines, Sethi told Health Imaging. Physicians who followed the guidelines would be indemnified from liability, he explained. Sethi also suggested that radiologists play an active role in clinical practice and discuss imaging studies with ordering physicians.

Computerized physician order entry and decision support may help curb inappropriate orders or defensive medicine. However, “If a physician feels [he or she] is going to get sued, the physician is going to do whatever has to be done and get the test one way or the other to avoid a lawsuit,” Sethi said.