Supplying Second Opinions

By Jeremy Smerd

Jul. 10, 2007

Sometimes, especially during complex, expensive medical cases or emergencies, doctors will misdiagnose an illness or mistakenly suggest a certain treatment. The result is poor but costly medical care. The reasons for errors are as varied and complex as the medical system.

    Many patients are not equipped to second-guess their doctor. Sometimes they seek another opinion; and sometimes that second opinion is given by a colleague of the first doctor who may not want to contradict his friend.

    Doctors have also been known to practice “defensive medicine” and over-prescribe treatments to avoid a malpractice lawsuit. Or, quite simply, doctors are overworked and don’t have enough time or information at hand to accurately assess a patient’s health.

    Such intricacies make it easy to understand why health care dollars are not spent wisely and why some employers want to cut costs by focusing on quality. The goal, to borrow a phrase from manufacturing, is to get the right treatment to the right patient at the right time.

    One strategy employed by companies like EMC Corp., ConAgra Foods and Waste Management Inc. is to provide employees the option of getting a second opinion from a company specializing in them.

    Best Doctors is a Boston-based company started by doctors affiliated with Harvard University School of Medicine who felt they could diagnose and treat illnesses accurately by having experts in their specialties exhaustively review patient medical data collected from doctors, labs, hospitals and pharmacies.

    “We’re not just saying to the patient, ‘Here’s a doctor. Good luck,’ ” says Best Doctors CEO David Seligman.

    Seligman says the second opinions given by the company’s stable of 50,000 physician specialists and nurses have altered people’s diagnoses 22 percent of the time and treatment in six cases out of 10, with 100 percent accuracy.

    In January, Boston-based data storage company EMC made Best Doctors available to its 19,000 U.S.-based employees after a trial run was deemed helpful in improving people’s medical care. Since then, 70 people on EMC’s health plan have used Best Doctors to get a second opinion; 88 percent have had their treatment plans changed and 12 percent have had a change in diagnosis, says Delia Vetter, senior director of benefits for EMC. So far the company has saved $80,000.

    Though EMC did not disclose the cost of the program—Best Doctors charges employers a monthly fee based on the number of employees with access to the service—Vetter says, “Ultimately, in the long term, we expect the program to pay for itself.”

    One patient’s severe dizziness was originally misdiagnosed as a rare disease caused in part by a swelling of fluids in the ear. Best Doctors’ specialist recommended repeating certain tests and consulting with a neurologist, who then re-diagnosed the illness as a type of migraine.

    Another patient was diagnosed with a pulmonary embolism, a condition that occurs when an artery in the lungs becomes blocked. The diagnosis was correct, but it turned out the prescribed surgery wasn’t needed, which saved the company $21,000.

    While the service is available free to all EMC employees, it’s particularly useful to the 6 percent of the workforce whose health care spending last year totaled half the company’s health care costs. EMC would not disclose how much it spent on health care, but its 2006 annual report shows that costs rose 9 percent last year, down from an increase of 11 percent in 2004.

    One EMC employee, Laura Aubut, a 44-year-old finance manager, had a particularly complex medical case. She says the in-depth assistance provided by Best Doctors, which she used during EMC’s trial run with the service, helped her make the right decisions along the way.

    In 2005, just days after giving birth to her second child, Aubut woke up with numbness in her right arm. Emergency room doctors told her she had had a small stroke. A blood clot in her leg slipped through a hole in her heart, into her bloodstream and up to her brain.

    “I was horrified,” she recalls.

    Around the time a specialist told her she needed to have the hole fixed, she learned of Best Doctors and decided to seek a second opinion.

    More than anything, Aubut was scared of surgery and overwhelmed by her circumstances. She wasn’t sure what to do.

    Best Doctors agreed that she needed to fix the hole. They also suggested seeing a neurologist. During this time, doctors told her she initially needed to treat a condition causing her internal bleeding. If she didn’t, she could bleed to death on the operating table, she was told.

    After treating that problem successfully, and satisfied she had done everything she could to make an informed decision, Aubut had the surgery. She praises Best Doctors for its guidance during a trying time.

    “I could have kept seeing one specialist after another,” she says. “But I said, ‘I’m comfortable with what I know now. I’m not scared now like I was before.’ “

Jeremy Smerd writes for Crain’s New York Business, a sister publication of Workforce Management.

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