With health care reform front and center in
“The way that we talk about reform is missing the quality issue,” according to Evan Falchuk, the president of Best Doctors and a former lawyer. “The way we measure quality in healthcare is with report cards which look at very odd, procedurally based metrics. Medical decisions are complicated. The way health care systems all over the world are set up, these complicated decisions are forced to be made in roughly ten minutes. It is a recipe for things to go wrong and a major problem in our healthcare system that is not being addressed by any of the reform discussions. The discussion is about who pays and how they pay.
“We are focused on the wrong thing because one of the major drivers of experience is misguided medical care. About 20 percent [of patients] have something wrong with their diagnosis and about half with their treatment. Data from thousands of cases show this,” Falchuk said.
Employers are buying Best Doctors services as an employee benefit to ensure their employees receive a higher quality of medical care, according to Falchuk. “If you feel unsure about your diagnosis or treatment, you are entitled to feel confident.”
While cancer is a frequent disease referred, Falchuk cited a recent case involving a woman with thyroid symptoms. She underwent a biopsy, which came back inconclusive for cancer. Her treating physician told her to come back in a year and “see how things are going,” Falchuk said. “She had seen our marketing material which said, ‘You are entitled to be confident in your diagnosis or treatment,’ and she called and said ‘I don’t like this.’”
A nurse member advocate from Best Doctors took her history and obtained her complete medical records including the original pathology. The Best Doctors’ clinical team determined what questions to ask and consulted with an expert pathologist, who re-examined her biopsy, and consulted an expert in thyroid conditions. They ultimately figured out what was wrong.” The Best Doctors’ expert pathologist found that the biopsy did not appear to normal. The Best Doctors thyroid expert recommended removal of the thyroid.
“She took our report back to her doctors and decided to remove her thyroid. We received an email from her saying that the surgery revealed that her thyroid had been cancerous and removing it was the right decision. ‘I had cancer and they were telling me to wait for a year. You changed my life; thank you so much,’ she said. Think of the real life — what this person would have gone through if she hadn’t picked up the phone and called Best Doctors. She had access to an employee benefit, so for her it was free.”
While these mistakes drive medical costs and cause unnecessary suffering, what is the cause of these problems? According to Falchuk, it is a “bad synthesis of information caused by not letting doctors have enough time with their patients. There is plenty of data that show the majority of doctor visits are less than 15 minutes long. A primary care physician or specialist sees about 30 or more patients per day.” It is difficult to provide continuity of treatment when a physician sees a couple thousand patients between a patient’s appointment and follow-up appointment.
Through Best Doctors, employees are matched with world-class experts who review their cases and provide treating physicians with a quality care roadmap. Why do treating physicians agree to this intervention? Best Doctors provides continuing education credits for doctors who participate. Using a collegial approach, attending physicians gain valuable knowledge and insight outside the classroom, so a Best Doctor assist is a win/win for both the patient and the physician.
Best Doctors also offers its medical expertise for workers’ compensation claims. American Reinsurance, a major reinsurer, asked the company to assist in managing catastrophic care. A five-year study completed by AmRe several years ago found that using Best Doctors reduced acute medical care costs by $287,567 per injury.
If you believe one of your workers is seriously injured but not getting the appropriate care, it may be a good idea to ask your insurance carrier to contact Best Doctors. Best Doctors offers several service pathways that can provide medical expertise and intervention that can reduce the costs of these claims. From chronic pain to catastrophic injuries, back injury to difficult cases, Best Doctors allows its clients to choose a level of service that provides the medical oversight needed to get the ill or injured worker on the right track.
Summing up his company’s philosophy, Falchuk strongly believes that patients must take an active role in their treatment and Best Doctors helps accomplish this. “The patient has the strongest incentive to get quality care. A patient has to be the driver in some respect.”
Why is the quality of health care quality your employees receive important? Your health plan may be “sensitive” to loss costs and poor loss histories may increase your premiums. In addition, losing a valued employee to an inaccurate diagnosis or treatment is never easy to watch and may hurt your ability to run your business. For more information, visit the Best Doctors Web site.