Malpractice Reform does not Affect ED Utilization

Waxman et al report in NEJM their findings regarding the effect legal reform had in the practice of medicine, in three states, Texas, Georgia, and South Carolina, which between 2003 and 2005, enacted legislation that changed the malpractice standard for emergency care to gross negligence.  

Using a 5% random sample of Medicare fee-for-service beneficiaries, they identified all emergency department visits to hospitals in the three reform states and in neighboring (control) states from 1997 through 2011. They compared patient-level outcomes, before and after legislation, in reform states and control states. Outcomes were policy-attributable changes in the use of computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions.

For eight of the nine states–outcome combinations tested, they found no reduction in the rates of CT or MRI utilization or hospital admission in any of the three reform states and no reduction in charges in Texas or South Carolina. In Georgia, reform was associated with a 3.6% reduction in per-visit emergency department charges.

They conclude that legislation that substantially changed the malpractice standard for emergency physicians in three states had little effect on the intensity of practice, as measured by imaging rates, average charges, or hospital admission rates.