Diabetes: Impact of local medicolegal landscapes on costs


More litigious U.S. states did not see decreased amputation rates over those where the medicolegal environment was less adverse, according to an analysis of Medicare data exploring the association between the realities of local medical-legal landscapes and diabetes-related care costs. 

A team of researchers from the Mayo Clinic Arizona in Phoenix and UMass Memorial Health in Worcester, Massachusetts, found that across U.S. states, a 1% increase in lawsuits per 100 physicians was associated with a greater than 10% increase in risk-adjusted standardized per-capita costs. An adverse medicolegal environment is “independently associated” with high healthcare costs, but doesn’t necessarily result in improved outcomes, they concluded.

Per-capita spending on diabetes ranged from $15,799 in states with infrequent and lower malpractice payouts compared to $18,838 on average in states with higher and more frequent settlements (p<0.05). Diabetic patients in states with adverse medicolegal environments had more procedures, imaging tests, and readmissions (p<0.05), Austin Pierce, MD, a general surgery resident from the Mayo Clinic, told the 2022 Vascular and Endovascular Surgery Society (VESS) winter annual meeting (Jan. 27–30) in Snowmass, Colorado, as the findings were presented for the first time. On multivariate analysis, amputation rates were associated with increased spending, co-morbidity prevalence, and race, but not medicolegal factors. 

“An adverse medicolegal environment is pretty clearly associated with higher healthcare spending, driven through greater intensity of service utilization,” senior study author Andrew J. Meltzer, MD, Mayo Clinic Arizona vascular chair, told Vascular Specialist. 

“The one thing that we can certainly measure in terms of outcomes based on available data, that’s relevant with our population in particular, would be amputation rates … this higher intensity of testing and higher spending does not correlate with any improvement in outcomes; it really simply reflects the external pressures that are placed upon those taking care of patients in an environment that is overly litigious.”


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