Marty Stempniak
Tort reforms appear to curb unnecessary use of imaging in the emergency department, according to new Neiman Health Policy Institute research published Wednesday.
Practicing “defensive medicine” to avoid any threat of being sued is a common explanation for why physicians order low-value scans that provide little benefit to patients. Researchers recently investigated whether state malpractice reform—i.e., caps on damages paid by defendants—curb the use of defensive imaging, sharing their findings in the American Journal of Roentgenology.
They found a clear correlation, with patients treated in states that have enacted reforms upward of 32% less likely to undergo certain low-value scans.
“Our findings reveal that tort reform in a state was associated with less use of advanced imaging for the common ED presentation of headache, highlighting how different medicolegal environments may impact defensive ordering of imaging,” study co-author John Jordan, MD, chair of the American College of Radiology Commission on Neuroradiology, said in a statement Oct. 29. “Understanding the impact of malpractice reform on imaging decisions is essential for informing policy that supports physicians’ appropriate clinical decisions and optimizes resource use.”
The study utilized 100% of Medicaid claims logged in 2019, altogether encompassing over 630,000 emergency department encounters for headaches. Nationwide, about 39% of these visits included advanced imaging to assess the patient. Computed tomography was the most common at 38%, followed CT angiography (2%) and MRI (1%). The state-level presence of damage caps was associated with a roughly 21% decrease in imaging utilization. Meanwhile, for patients treated in states with “several liability” reform—when a defendant is only held liable for the share of damages they directly caused—the likelihood of imaging was 32% lower.
Other factors also appeared to impact patients’ odds of receiving low-value imaging, the study found. For instance, those treated at facilities with fewer than 100 beds were about 35% less likely to receive such scans for a nontraumatic headache. Conversely, those seen by a referring physician other than an emergency medicine specialist were over eight times likelier to undergo unnecessary imaging, the authors found.
“Our study did not explain why this discrepancy exists, but it should be the focus of future research,” co-author Elizabeth Rula, PhD, executive director of the Neiman Health Policy Institute, which was established by the ACR in 2012, said in the same statement.
Read more about the results, including potential study limitations, in the official journal of the American Roentgen Ray Society.