Rates of paid malpractice claims decrease in cardiology, other medical specialties

Between 1992 and 2014, the rate of paid malpractice claims decreased 13.5 percent in cardiology and declined 55.7 percent in all medical specialties, according to a database analysis.

Still, the mean malpractice payment increased 9.1 percent in cardiology and 23.3 percent in all medical specialties (adjusted for 2014 dollars) during the study.

Lead researcher Adam C. Shaffer, MD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues published their results online in JAMA Internal Medicine on March 27.

The researchers examined malpractice claims from 1992 to 2004 from the National Practitioner Data Bank, which Congress created in 1986 as a database for malpractice claims paid on behalf of U.S. physicians. They then linked the malpractice claims with physician’s specialty, which they obtained from the American Medical Association Physician Masterfile.

From 1992 to 2014, there were a total of 280,368 malpractice claims paid for 175,667 physicians. The annual overall rate of paid malpractice claims was 14.1 per 1,000 physician-years.

During that time period, the rate of paid malpractice claims declined by 55.7 percent from 20.1 per 1,000 physician-years during 1992 to 1996 to 8.9 per 1,000 physician-years during 2009 to 2014. There was a decline in each of the 24 specialties that the researchers evaluated.

The largest decline was a 75.8 percent decrease in pediatrics from 9.9 to 2.4 per 1,000 physician-years, while cardiology has the smallest decline at a 13.5 percent decrease from 15.6 to 13.5 per 1,000 physician-years.

For all claims, the mean payment was $329,565, ranging from $189,065 in dermatology to $469,222 in neurosurgery. The mean payment for cardiology was $365,029.

During the study, the mean payment adjusted to 2014 dollars increased 23.3 percent from $286,751 in 1992 to 1996 to $353,473 in 2009 to 2014. There was a statistically significant mean increase in 16 of 24 specialties. For cardiology, there was a 9.1 percent increase in mean payment from $337,605 to $368,350.

The researchers also found that the 1 percent of physicians with the highest number of paid claims had 7.6 percent of all paid claims. Meanwhile, the 5 percent of physicians with the highest number of paid claims had 23.3 percent of all paid claims, while the 10 percent of physicians with the highest number of paid claims had 39.4 percent of all paid claims.

In addition, paid malpractice claims exceeding $1 million comprised 7.6 percent of paid claims and accounted for 6.2 percent of paid claims in 1992 to 1996 and 8 percent of paid claims in 2009 to 2014. The percentage of catastrophic claims increased in 23 of the 24 specialties, including cardiology.

Further, the most common type of allegation for paid claims was an error in diagnosis, which occurred in 31.8 percent of paid claims. The next most common types of allegations were errors related to surgery (26.9 percent of paid claims) and errors related to medication or treatment (24.5 percent).

The researchers mentioned a few possibilities for the decline in the rate of claims paid on behalf of physicians, including the passage of traditional tort reforms and improvements in patient safety during the time period. Other explanations include the manner by which institutions and insurers resolve claims and the increasing prevalence of communication and resolution programs. Still, the study was not powered to provide definitive reasons for the decline in the rate of claims paid.

"Previous research has shown that physicians' perceptions of their risk of liability can influence their clinical decision making, and a better understanding of the causes of variation among specialties in paid malpractice claims may both improve patient safety and reduce liability risk," Allen Kachalia, MD, chief quality officer at Brigham and Women’s Hospital and senior author of the study, said in a news release.

The study had a few limitations, according to the researchers, including that they could not count claims for which no payment was made, that were settled without a written demand or those in which payment was made solely on behalf of an institution. They also noted that they could not account for the clinical volume of the physician, which could affect the physician’s liability exposure.

“There were wide differences in rates of paid claims and characteristics of the alleged injuries across specialties,” the researchers wrote. “A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce patient injury and physicians’ risk of liability.”