Within Gastroenterology, Spending on Average Indemnity and Defense Is on the Rise

Diagnostic procedures of the large intestine were the most common claims within those against gastroenterologists, making up 26% of all closed claims.

The cost of practicing defensive medicine has ballooned in recent years thanks to rising malpractice insurance premiums driven by a spike in medical malpractice claims across all disciplines. But the trends in gastroenterology, a procedure-oriented specialty, have yet to be studied.

Investigators sought to explore trends in the field by performing a retrospective analysis of medical professional liability (MPL) claims data, including diagnoses and endoscopy related claims, in order to better educate gastroenterologists about risk management.

In a session at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, Texas, the research team presented its findings after analyzing claims data obtained from the MPL Association (formerly the Physician Insurers Association of America Data Sharing Project) spanning from 2006 to 2015.

To compare trends over time, investigators pulled data—including the patients’ presenting medical condition, operative procedure, outcomes of the claims, and costs associated with the closed claims—and separated it into 2 groups: claims from 2006-2010 and claims from 2011-2015.

A total of 90,743 MPL claims were closed from 2006-2015, of which 2.07% (1879/90,743) were closed claims and 1.5% (367/24,106) were paid claims against gastroenterologists. Seventy-one percent of the claims against gastroenterologists were dropped, withdrawn, or dismissed.

Diagnostic procedures of the large intestine were the most common claims within those against gastroenterologists, making up 26% of all closed claims leading to a payment of $18,392,668 in total and $301,519 as average indemnity. Diagnostic procedures of the gallbladder and biliary tract, including endoscopic retrograde cholangio-pancreatography (ERCP) procedures, had the highest average indemnity ($484,364), followed by procedures involving the small intestine ($336,078), large intestine ($301,519), and esophagus ($267,577).

The average indemnity rose 8.2% from 2006-2010 to 2011-2015, from $341,563 to $369,508. For the respective time periods, the amount spent on legal defense for gastroenterology-related claims increased 8.7% from $44,625 vs. $48,506.

In an interview with MD Magazine® at ACG 2019, presenting author Mahendran Jayaraj, MD, assistant professor of medicine at University of Nevada, Las Vegas, explained what may be driving the recent increase in these claims.

Investigators plan to further study what variables in particular are affecting the trends.

“Gastroenterology specialty has an increasing trend in spending on average indemnity and defense,” the research team concluded. “Diagnostic procedures of the biliary tract, including ERCP, have the highest average indemnity among the endoscopic procedures. Adequate endoscopic training, meticulous focus on procedural indication, and well-informed consent might help to reduce the costs associated with claims.”

The study, Recent Trends in Gastroenterology and Endoscopy Related Medical Professional Liability Claims in the United States of America, was presented Monday, October 28, 2019, at the American College of Gastroenterology Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.