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Second opinions, as a job benefit

The costs of misdiagnoses spur employers to act

After a second opinion, Cathy Meyers’ cancer treatment changed and her health improved.
After a second opinion, Cathy Meyers’ cancer treatment changed and her health improved. (Laura Segall for The Boston Globe)

Here’s a scary statistic: More than 1 in 5 medical diagnoses and treatment plans may be wrong.

When patients are put on an inappropriate medication or an incorrect dose, they don’t get the right tests or the best possible care. Those errors may simply be missed opportunities, or they could threaten a person’s life.

Tired of such inaccuracies, employers who subsidize health insurance for millions of workers are offering free second opinions and medical care reviews as employee benefits.

And the few organizations that offer those services are thriving.

Best Doctors, founded 22 years ago by several Boston physicians, posted a three-year growth of 116 percent, with 2010 revenue of $92.7 million. An employer-funded treatment service at the Cleveland Clinic is expanding from heart valve replacements into orthopedics, spine surgery, and complex neurosurgery. And a second-opinion program at Partners HealthCare, parent company of Brigham and Women’s and Massachusetts General hospitals, reports growing demand.

Though these services each operate a little differently, they are all designed to help people like Cathy Meyers.

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Meyers, 59, who lives near Phoenix, took a job at Home Depot five years ago because she needed health coverage and wanted a change from her career in the insurance industry.

A few years later, she began having stomach pains. She was diagnosed with pancreatic cancer that had spread to her liver. Meyers started on an aggressive chemotherapy regimen and responded well, allowing her to return to work.

But eight months later there was another unwelcome shadow on her scan.

After the next treatment failed, her doctor said there was little more he could do, other than sign her up for experimental clinical trials. Desperate for more options, Meyers started calling around. Two other oncologists who reviewed her file suggested she restart the chemotherapy that had worked so well a year earlier. Initially hesitant, her doctor agreed.

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Then Meyers got a flier from Home Depot announcing it had signed a deal with Best Doctors and offering her a free medical review. Through the service, a team including a pathologist at Brigham and Women’s in Boston was hired to review Meyers’ original biopsy - and they interpreted it differently.

Yes, she had the same rare type of pancreatic cancer that recently killed Apple founder Steve Jobs. But hers was a somewhat different type than her doctor had diagnosed. That meant an entirely different kind of treatment.

Now, she gets a monthly injection of hormones instead of toxic chemotherapy. Her long-term prognosis is very good.

“My specialist has had people on this regimen for over 20 years,’’ Meyers said. “I have a future of hope.’’

Best Doctors’ president, Evan Falchuk, whose father helped found the company, said his firm repeatedly catches such diagnostic missteps.

Best Doctors, which represents companies with 30 million employees, changes 22 percent of diagnoses and 61 percent of treatment plans; 38 percent of patients are told they don’t need the surgery their doctors had recommended.

The Cleveland Clinic, which also serves millions of employees, suggests changes in diagnoses or treatment in more than a quarter of the cases it reviews in its MyConsult online second-opinion program, said Dr. Jonathan Schaffer, an orthopedic surgeon and managing director of eCleveland Clinic.

A 2001 study of autopsies found that the stated cause of death disagreed with the actual cause 1 time in 5, suggesting vast numbers of misdiagnosed patients. In 44 percent of those cases, the correct diagnosis would have changed treatment, according to the study, published in the journal Chest.

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“It’s pretty clear to everyone that although we have exceptional quality in a lot of places in the American health care system, the quality and outcomes are uneven,’’ said Michael McMillan, executive director of market and network services for the Cleveland Clinic. “Improving that for all patients is an important objective.’’

Meyers said she doesn’t blame her pathologist in Arizona for the missed diagnosis. He simply doesn’t see enough cases like hers.

All three second-opinion providers agree: It’s not that US doctors are lousy or lazy. They just don’t see the same volume of cases as the specialists in Boston or Cleveland. Or they don’t have the time to take the extremely detailed family history that would have revealed information key to a correct diagnosis. Or they don’t have access to top-notch colleagues to bounce ideas off of and keep them up to date.

“Using an academic source of truth is appealing’’ to health insurance plans and companies, said Dr. Joseph C. Kvedar, a Harvard Medical School associate professor who directs the Partners Center for Connected Health, which runs its second-opinion service.

Cleveland Clinic, Best Doctors, and Partners say their services are cost-effective for companies as well as for patients.

Meyers is back to selling appliances, saving Home Depot money on retraining and on the cost of unneeded chemotherapy.

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Lowe’s Cos., which pays the Cleveland Clinic to handle heart valve replacements for employees nationwide, saves money when doctors repair rather than replace valves, McMillan said. Repairs have fewer side effects and shorter recovery times but are harder to perform, he said, so the success rate is higher in a place like Cleveland that does them often.

And Dr. K. Andrew Crighton, chief medical officer of the financial giant Prudential, said his company’s work with Best Doctors has exceeded his expectations. Since the program was launched in April, 375 employees have used it - 176 percent more than forecast.

“We are anticipating that we will have a positive return on investment,’’ he said. “But even having just one or two people avoid unnecessary surgery or treatment and potential complications makes it worthwhile. When you can get the treatment right, that’s a win for everybody.’’


Karen Weintraub can be reached at karen@karenweintraub.com.