October 4, 2016
By Dr. Lewis Levy, Chief Medical Officer, Best Doctors
Recently, a 50-year old woman with multiple sclerosis was referred by her health plan’s case manager to Best Doctors for a second opinion. She had developed chronic lower extremity pressure ulcers and had been diagnosed with osteomyelitis, a serious bone infection.
After multiple hospitalizations for antibiotic therapy and debridement procedures, she had five skin graft procedures and ongoing wound care for a physically and emotionally taxing situation. Despite aggressive treatment, instead of improving, her condition worsened. If you were to ask her, the worst part was simply not knowing if all the procedures and efforts were actually addressing the painful problem.
After a careful review of her case, the expert physicians at Best Doctors found enough evidence to change her diagnosis from osteomyelitis to suboptimal blood flow to the leg. That one change altered her treatment plan dramatically, and put her on the path to recovery. Most of all, she has the peace of mind knowing that her diagnosis is now correct and her treatment plan reflects that. She remarks, “I have my answer now. I have my life back.”
Every day, far too many people struggle with medical uncertainty, that limbo somewhere outside of a confirmed diagnosis and accurate treatment plan. It’s a vicious cycle of incorrect or unconfirmed diagnoses and expensive or harmful treatments that may or may not be addressing the actual problem. Diagnostic errors are an enormous problem in U.S. healthcare. According to a 2016 BMJ study, medical errors accounted for the third leading cause of death in the United States, higher than deaths from diabetes or breast cancer or motor vehicle accidents. A study from the Kaiser Family Foundation found that nearly one in three patients indicated that they or somebody in their family had been affected by a preventable medical error, with 21 percent suffering a serious health consequence.
As you can imagine, any case of misdiagnosis causes additional suffering for patients and their families – but it also causes the financial burden of wasted spending on patients, employers, labor funds and the health care system. The Institute of Medicine (IOM) estimates that one out of every three healthcare dollars spent is wasted, so of the $2.8 trillion expended on healthcare annually, nearly $1 trillion is spent needlessly. Many of those wasted dollars can be tied back to an incorrect or incomplete diagnosis.
Strategies to Improve Diagnostic Accuracy Diagnostic accuracy has a significant impact on member health outcomes and on reducing and controlling costs. As it becomes a higher priority, strategies for lowering diagnostic error are emerging, including:
Incorporating programs to ensure diagnostic accuracy within value based arrangements
Leveraging technology and data at the point of care to identify potential cases of misdiagnosis
Educating consumers on the importance of independent second opinions prior to starting high-cost or high-risk treatment
Using plan design with incentives and disincentives to drive members to Treatment Decision Support and other clinical advocacy programs to create informed consumers of health care
What else can we be doing to increase the rate of diagnostic accuracy?
Make second opinions more easily available. In addition to traditional second opinions, in-depth remote second opinions (for which the patient need not travel or make additional physician visits) are now readily available to millions of people in the US. Many of the world’s leading plan sponsors offer expert second opinions as a valued employee benefit that can save healthcare dollars by averting unnecessary or even harmful testing and treatment, decrease absenteeism, and promote employee retention. Plan sponsors should be proactive in reminding their teams of these services and encouraging anyone with medical uncertainty to take advantage of them.
These services dedicate a large amount of effort to gathering all medical records, retesting pathologies, and providing access to leading physicians at major medical institutions of excellence. Taking enough time to synthesize and review each case is extremely important, as even excellent doctors can miss key information when harried by the time pressures faced by most U.S. physicians.
Second-opinion medical services offer plan sponsors an effective way to contain costs for complex medical cases and reassure members that their diagnoses and treatment plans are correct. In a recent study of cases in Q1 of 2016 referred by a large Blues plan to Best Doctors, Inc. for a large member population, there was a major impact in terms of changing the diagnosis in 49% of cases. The Company also found that 79% of the time there was a major impact on modifying the treatment plan based on a new or confirmed diagnosis. Savings just from averted medical costs exceeded a 2:1 ratio.
Regardless of the strategy undertaken, the evidence is overwhelming that incorrect and incomplete diagnoses are much more prevalent than we may have imagined. However, there is reason for hope, as many leading health plans, employers, and labor organizations are now beginning to study the problem and determine long-term solutions.
***Dr. Lewis Levy serves as Chief Medical Officer at Best Doctors, Inc., the global health company that brings together the best medical minds to help physicians get the right diagnosis and recommend the right treatment. In addition to over 25 years of clinical experience, Dr. Levy also has an extensive teaching career as an instructor at Harvard Medical School. Best Doctors is a member of the Association of Benefit Administrators and an endorsed vendor of the National Labor Alliance. Charles Gustafson, email@example.com, (860) 983-5025 is their local representative.