The survey notes that while many policy makers, academics, and others identify fee-for-service reimbursement as a key driver of health care costs, physicians believe that "defensive medicine is a far more important cost driver."
"Medical malpractice lawsuits, a rarity prior to the era of medical specialization, now are common, adding an additional layer of paperwork, expense, and stress in virtually every physician's work day," the report adds.
While states have enacted tort reform, it has been sporadic nationwide, with no clear national focus, Ray says. "Individual states have taken their own strides," Ray says. "Some states have never gotten tort reform going."
Medical malpractice goes to the heart of overspending in American healthcare, yet has not been fully addressed either by states, the federal government, or in healthcare reform, Ray says. "It is ironic that part of the Patient Protection and Affordable Care Act was to bend the cost curve, to prevent unnecessary testing," he says.
"Why do many physicians move ahead with all those unnecessary procedures? Because of the fear of malpractice. And one of the things that stood out in the PPACA was its failure to address tort reform. It's really ironic to physicians what's going on."