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Reducing the costs of misdiagnosis

Hospitals and practices turn to clinical diagnosis tools minimize patient harm and misdiagnosis costs

The statistics are disturbing: between 10 percent and 15 percent of medical diagnoses are incorrect and those diagnostic errors have a high price tag. To combat potential patient harm and reduce the costs from misdiagnosis, hospitals and medical practices are turning to clinical decision support tools.

A recent analysis published in BMJ Quality and Safety examined malpractice claims over 25 years, identifying more than 100,000 cases that involved diagnostic error, with an average price of $386,849 per claim. An earlier study published in the same journal estimated that diagnostic errors account for 40,000 to 80,000 hospital deaths yearly in the U.S.

[See also: Malpractice not cause of healthcare cost]

Healthcare experts and vendors are trying to address this national problem in a variety of ways.  The widespread adoption of EHRs will likely help reduce the deaths and injuries that can result from misdiagnosis because many are now equipped with clinical decision support (CDS) software to help physicians pinpoint the correct diagnosis.

Several hospitals and practices rely on UpToDate, for instance, to power their CDS system. The searchable database has been featured in over 30 research studies, many of which suggest the program improves diagnosis and treatment.

One such study – a Harvard University investigation – concluded that the use of UpToDate over a three-year period shortened length of hospital stay, saving 370,000 days per year, and lowered mortality rates.

While the study did not calculate the cost savings from the lowered mortality, it’s not unreasonable to theorize that such programs can reduce healthcare expenditure.

For example, said Denise S. Basow, MD, president and editor in chief at UpToDate, some clinicians start down the wrong diagnostic path and “that ends up costing money to the system because you go down a path of testing that ends up not being fruitful.” In the worst case, it also causes harm to the patient because the correct diagnosis is not made in a timely fashion. A variety of differential diagnostic tools are available that help improve a clinician’s decision-making process in this kind of scenario, explained Basow.

On the other hand, some physicians, after taking a detailed medical history, may have a tentative diagnosis in mind and need help confirming it and that is where clinical decision support tools are most useful, she said. UpToDate, for example, features a database that can provide a list of possible tests to rule out various disorders.

Other CDS tools, like ConsultingMD (soon to be renamed GrandRounds) take a very different approach to solving the misdiagnosis dilemma. The company offers access to individualized second opinions from well-respected medical experts in a variety of specialties.

Owen Tripp, the CEO of ConsultingMD, said that their medical experts represent every major specialty and have demonstrated exceptional clinical outcomes data and that patients managed with help of its medical experts have a 30 percent shorter hospital stay.

About 90 percent of ConsultingMD’s members receive the service through their employer. Employers pay $10 per employee per month for groups of fewer than 5,000 people. For those not covered by their employer, the direct cost is $3,750 per case.

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