Impact Of “Defensive Medicine” On The Costs Of Diabetes And Associated Conditions

Abstract

OBJECTIVES This study explores the association between the medicolegal environment and Medicare costs for Diabetes and associated conditions of interest to vascular surgeons. METHODS The 2018 Medicare Geographic Variation Public Use Files and Chronic Conditions Data Files were linked to National Practitioner Database files from the preceding 5 years, in addition to US Census data and AMA workforce statistics. State-level medicolegal environment was characterized by K-means clustering across a panel of metrics related to malpractice payment magnitude and prevalence. RESULTS Median (IQR) unadjusted Medicare per-capita expenditure on diabetic patients was $15,963 ($14,885 to $17,673), ranging from $13,762 (Iowa) to $21,865 (D.C.). Cluster analysis based on malpractice-related variables yields 5 distinct medicolegal environments. Per-capita spending on diabetes ranged from $15,799 in medicolegally favorable states to $18,838 in more adverse medicolegal environments. Malpractice claim prevalence was an independent predictor of states with the highest DM spending [Table1]. Diabetic patients in states with adverse medicolegal environments had more procedures, imaging tests, and readmissions (p<0.05). By multivariate analysis, amputation rates were associated with cost, co-morbidity prevalence, and race, but not medicolegal factors. CONCLUSION This study explores the association between the medicolegal environment and Medicare costs for Diabetes and associated conditions of interest to vascular surgeons. The 2018 Medicare Geographic Variation Public Use Files and Chronic Conditions Data Files were linked to National Practitioner Database files from the preceding 5 years, in addition to US Census data and AMA workforce statistics. State-level medicolegal environment was characterized by K-means clustering across a panel of metrics related to malpractice payment magnitude and prevalence. Median (IQR) unadjusted Medicare per-capita expenditure on diabetic patients was $15,963 ($14,885 to $17,673), ranging from $13,762 (Iowa) to $21,865 (D.C.). Cluster analysis based on malpractice-related variables yields 5 distinct medicolegal environments. Per-capita spending on diabetes ranged from $15,799 in medicolegally favorable states to $18,838 in more adverse medicolegal environments. Malpractice claim prevalence was an independent predictor of states with the highest DM spending [Table1]. Diabetic patients in states with adverse medicolegal environments had more procedures, imaging tests, and readmissions (p<0.05). By multivariate analysis, amputation rates were associated with cost, co-morbidity prevalence, and race, but not medicolegal factors.