Poll: Half of ED physicians practice defensive medicine

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Nearly half (44 percent) of almost 1,800 emergency physicians reported that the biggest challenge to cutting costs in the emergency department is the fear of lawsuits, according to a poll conducted by the American College of Emergency Physicians (ACEP). In addition, 53 percent of respondents said the main reason they conduct the number of tests they do is the fear of being sued.

ACEP is using these findings to press its case for tort reform.

"Medical liability reform is essential to meaningful healthcare reform," said ACEP President Sandra Schneider, MD. "Without it, healthcare costs will continue to rise. Estimates on the costs of defensive medicine range from $60 billion to $151 billion per year. That dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2 percent of all healthcare spending."

Sixty-eight percent of poll respondents said there has been no improvement in the number of medical specialists willing to take call in the emergency department since healthcare reform legislation passed last year. Many specialists cite the fear of being sued as one of the top reasons they will not treat emergency patients. Emergency care is considered high-risk for liability, because patients are more seriously ill or injured and physicians often don’t have access to their medical histories. The on-call specialist shortage has been linked to emergency department deaths and permanent injury.

ACEP supports two pieces of legislation proposed in the U.S. House of Representatives, HR 5 and HR 157, which are both aimed at liability reform. H.R. 157 would extend the same legal protection that physicians in the Public Health Service have to physicians who care for patients in emergency departments. Emergency physicians are required by federal law to treat all patients, and often treat time-sensitive patients without any knowledge of their medical history. HR 5 recently cleared through the House Energy and Commerce Committee and will come up for a floor vote soon.

Schneider also raised an issue related to the development of quality measures for medical care, some of which are designed to discourage the overuse of testing.

"The federal government is making great efforts to implement quality measures, but without federal medical liability reform, physicians following the guidelines developed by the Centers for Medicare & Medicaid Services [CMS] may open themselves to litigation," said Schneider. "For example, under new CMS guidelines, the use of head CTs is being discouraged. Fewer head CTs will mean that physicians miss maybe 1 percent of serious head bleeds. So a small percentage of people with head bleeds will be missed, and there are no liability protections for those physicians who may be sued as a result."

ACEP conducted the poll from March 3 to March 11. E-mails were sent to 20,687 emergency physicians, and 1,768 responded. The survey has a theoretical sampling error range of approximately 2.23.