Among orthopedists, defensive imaging is both common and costly, according to a prospective practice audit in The Journal of Bone & Joint Surgery.
Here are seven things to know.
1. An anonymous, prospective audit surveyed 72 Pennsylvania Orthopaedic Society members on consecutive imaging decisions in their practice. For each image order, respondents recorded the modality, body region imaged and whether the imaging was clinically required or ordered for defensive purposes.
2. The researchers evaluated the proportion of defensively-ordered imaging and evaluated its total cost using 2009 Medicare reimbursement rates.
3. The orthopedists recorded 2,068 imaging decisions the day that their practice was audited. Defensive imaging represented 396 imaging orders, or 19.1 percent, and 34.7 percent of the total cost — $113,675 of $327,414.
4. MRI represented 48.7 percent of the defensive orders, and 193 of the 501 MRIs — 38.5 percent — were ordered for defensive reasons.
5. The proportion of defensive imaging ordered by orthopedists who had been sued for medical malpractice within the previous five years — 24.6 percent — was significantly greater than the proportion — 15.1 percent — ordered by those who had not been sued during the period.
6. The proportion of defensive imaging ordered by orthopedists who had been in practice for more than fifteen years — 20.8 percent — was significantly greater than the 17.1 percent ordered by those with fewer years of experience.
7. Recent litigation and longer practice length were associated with an increased rate of defensive imaging. The real-time audit also demonstrated that large proportion of MRI studies were ordered mostly for defensive medicine reasons.
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