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FRANKLIN, Tenn. - June 7, 2011

New Evidence Supports the Role of Specialization in Reducing Diagnostic Error

Specialized Radiologists are 34 percent more accurate than generalists, providing clear patient benefit

The issue of diagnostic accuracy and the public health implications and cost of diagnostic error continue to make headlines and challenge U.S. juries alike.

A recent jury verdict focused attention on the issue of misdiagnosis and the role specialized radiologists can play in preventing it after the family of a Missouri woman filed suit against the general radiologist who failed to detect a fatal brain aneurysm on her CT scan. The jury ruled in favor of the general radiologist despite the aneurysm being readily identified by another radiologist during subsequent reviews. The radiologist who readily identified the aneurysm was a neuroradiologist—a specialized radiologist with specific expertise in reading brain and spine scans.

In today's highly specialized medical environment, referring a patient with a specific problem or condition to a medical specialist is a recognized best practice. However, many patients are surprised to learn their diagnostic imaging results are typically reviewed by a general radiologist. In fact, some experts believe misdiagnosis persists because clinical best practices such as specialization, which is readily adapted in other areas of medicine, are not well leveraged in the diagnostic process.

The Wall Street Journal, reporting on the controversy over use of certain statistical concepts in seeking FDA approval of a pharmaceutical to be used as part of a test for Alzheimer's, recently made the case for specialization and innovations in medical imaging to boost diagnostic accuracy. A cognitive neuroscientist who was a member of the FDA's advisory panel summarizes the argument for specialists, who have the opportunity to build their skill at interpreting results, stating, "It is better to have one person reading 500 scans a day than 500 people reading one a day." [1]

"The Missouri case, while tragic, sends a clear message to patients about the importance of knowing who is reading your scan," says Norman Scarborough, M.D., vice president and senior medical director of MedSolutions. "Patients undergoing brain surgery have the right to expect that it will be performed by a specialist – a neurosurgeon – but in today's healthcare model, the same expectation does not hold true for the radiologist who reads and interprets their brain scan. General radiologists are often asked to review complex scans better suited for radiologists who specialize in a particular area of the body. "

Often unrecognized or unreported, diagnostic errors are responsible for an estimated 40,000 to 80,000 hospital deaths a year and account for 40 percent of all malpractice cases. [2] Errors reading MRI and CT scans are a major contributor to misdiagnosis. According to one recent study that identified diagnostic errors over a several year period, 54 percent resulted from the interpretation of general radiography, with CT and MRI reading errors accounting for 32 percent of those errors. [3]

Research has long affirmed that a physician's degree of specialization and volume of experience reading certain types of scans dramatically increase the probability of accurate diagnosis. According to one study, neuroradiologists were 34 percent more accurate than generalists in interpreting neurologically focused studies.[4] A separate study found that radiologists who specialize in interpreting mammography studies were 76 percent more likely than general radiologists to detect breast cancer. The subspecialists identified more than 75 percent more cancers in an early stage, dramatically impacting survival rates and overall cost of care. [5]

Leading patient safety advocates, including Johns Hopkins experts David Newman-Toker, M.D., Ph.D., and Peter Pronovost, M.D., Ph.D., maintain that tools such as screening checklists and the use of independent diagnostic experts to review imaging test results are practical, low-cost solutions to reducing misdiagnosis.

"Sadly, it's the patient who pays the ultimate price. Patients shouldn't have to endure the cost, pain or uncertainty of unnecessary and invasive procedures or delays in care that result from misdiagnosis," said Gregg Allen, M.D., chief medical officer of MedSolutions. "Our research and experience show that connecting a patient with a diagnostic specialist whose background and expertise match the patient's needs not only improves quality of care, but also reduces cost."

Finding the right radiology subspecialist can present challenges for many patients and providers; however, some innovative health plans are looking for a way to address this critical issue. A leading health plan recently implemented a program focused on improving diagnostic accuracy for members in a large metropolitan market. The program reduced hospital length of stay by 1.5 days and decreased ER usage by 50 percent, improving the quality and cost of care for members. Participants also required about 30 percent fewer outpatient services.

In addition to improved quality of care, the plan has experienced a per member annual savings of $1,575. Members benefit from reduced health risks of unnecessary surgeries, biopsies, treatments and medications, as well as the associated out-of-pocket costs.

The Premerus® Diagnostic Accuracy program, offered by MedSolutions, provides health plans and the members they serve with a proven solution to the problem of misdiagnosis. Founded on the principle that diagnostic accuracy improves patient outcomes, enhances quality of care and reduces overall healthcare costs, Premerus utilizes secure clinical technology to connect patients with diagnostic specialists whose background and expertise best matches their need and provides timely and accurate interpretations to the treating physician.

About MEDSOLUTIONS
Using independently validated savings methodologies, MedSolutions specializes in quality-driven intelligent cost management of medical services for commercial, Medicare and Medicaid payers. The company maintains management contracts for more than 33 million individuals nationwide. Using robust data, predictive intelligence technology and evidence-based clinical expertise, the company's innovative solutions extend beyond Radiology Management to other areas of medical specialty, including Oncology, Cardiac Imaging, Sleep, Ultrasound, and MedSolutions' groundbreaking Premerus® Diagnostic Accuracy program – the nation's first solution for reducing diagnostic error rates to improve the quality and cost of care. MedSolutions has been recognized for outstanding customer service and effective call center management by the International Customer Management Institute and for four consecutive years by the prestigious J.D. Power and Associates Award. Visit www.medsolutions.com.

About Premerus® DIAGNOSTIC ACCURACY
Premerus® is a groundbreaking solution from MedSolutions that addresses the significant problem of error in the diagnostic process. Premerus® increases accuracy in the interpretation of diagnostic imaging studies to eliminate the risk of unnecessary and misguided treatments and improve the quality and cost of patient care. Premerus® is the nation's first diagnostic platform that delivers access to the specialty expertise of some of America's leading diagnostic physicians. Using proprietary technology to match individual cases with the proven skill and improved accuracy of diagnostic specialists, Premerus® efficiently routes clinical data and images to leading diagnosticians for expeditious review. The unparalleled quality of Premerus® is built on the patent-pending Certified Premerus® Expert process, which aligns and rigorously certifies diagnostic physicians within their specific area of expertise, thereby assuring an accurate initial diagnosis that leads to higher quality, more efficacious care. For more information, visit www.medsolutions.com/premerus.

[1]“Mind the Median,” Wall Street Journal, May 20, 2011 http://blogs.wsj.com/numbersguy/mind-the-median-1061/

[2] ”What the Doctor Missed” Wall Street Journal, Sept. 28, 2010
http://online.wsj.com/article_email/SB10001424052748703694204575517834198205438-lMyQjAxMTAwMDIwODEyNDgyWj.html#

[3] Diagnostic Imaging, December 1, 2010 To Err is Human; Analysis Finds Radiologists Very Human
http://www.diagnosticimaging.com/conference-reports/rsna2010/content/article/113619/1745046

[4] Clinical Radiology 2008, 63 (7), 791-5

[5] Radiology 224(39), 861-9,2002