Why do we spend so much in orthopedics? Part 1

October 13, 2020

Part 1: Inaccurate Diagnosis and Inappropriate Care

You hurt your knee and think you heard a pop.  You can walk and hesitating on what to do next.  People around you are telling you to go to the ER.  Your insurance plan says you need to see these specific providers first and your uncle is saying go to a chiropractor (he loves his)…..

In our experience the next decision on your knee is critical to obtaining high quality care and frankly getting better the quickest.

In this article we are going to focus on the impacts of seeing an under-qualified professional first and why it is so important to get to a specialist immediately.  We use the knee example in addition to showing what we see in employer healthcare claims data.

Back to your injured knee:
What are your options for treatment on your knee and how long until you see someone:

Musculoskeletal Care Provider Options
Approximate time to care varies by location, physician and a number of other factors

*Merritt Hawkins, 2017 Survey of Physician Wait Times by Speciality

Getting to an orthopedic surgeon takes the longest 21 days and often much longer for the best orthopedic doctors.  In our experience, patients are going to generalists for immediate pain relief (also at the direction of their health plan/insurance).  Here is a list of the most qualified musculoskeletal experts by years of training.

Orthopedic surgeon
Orthopedic Physicians Assistant (PA)
Orthopedic Nurse Practitioner
Doctor of Physical Therapy
Orthopedic Nurse
Primary Care Physician
General Nurse
Emergency Medical Technician

What is happening to patients today with Musculoskeletal injuries?

We have reviewed over 1 million historical healthcare claims to see what we decisions patients actually make on their care, who they see and for how long.  

Claims data shows us where the rubber hits the road. Here is an example of a patient we will call George that shows a common care pathway that we see in knee pain.

Care Pathway for George and his knee pain care

What we see in our example of “George”  

  • George went to the primary care doctor first
  • George got a number of injections with confusing intervals (in our opinion)  
  • We see a number of continued visits to the primary care doctor with no escalation
  • A scan was performed 1 year after the injury occurred
  • For knee pain we don’t see much progress with this patients care plan

After our musculoskeletal experts spoke to him about his care, they found the patient’s knee injections were in the incorrect area of the knee and using incorrect medication/dosage…

Our conclusion on George: the patient got an inappropriate diagnosis.  This lead to unnecessary care not advancing the patient’s condition (making them better).

The Root Cause:

George went to see a generalist with minimal training in orthopedics and got unnecessary care which did not progress the injury appropriately.  This delayed the correct treatment to get him better.

Taking it back to your knee, if you get the wrong/inaccurate diagnosis you end up obtaining inappropriate care.  Quite simply solving the wrong problem.  

It takes patients so long to get to a qualified clinician invested in good outcomes.  This makes it very difficult to get the correct diagnosis and get to the root cause of the injury.  

We often compare the example of a leaking toilet: If you had a leak in your toilet, would you call your general contractor or a plumber?

The Importance of a Specialist:

When seeing a specialist, they ask more specific questions and perform more specific tests.  They have seen much more of the nuances with musculoskeletal care Often it does not take them long to quickly diagnose your issue.

We think it is critical to get to the most experienced specialist for your injury or disease as quickly as possible to avoid incorrect or delayed diagnosis leading to unnecessary care.

So this begs the question, how do I get to an expert quickly if the systems we have in place prevent this from occurring.  

At MDDirect we are experts in musculoskeletal care and working with claims data.  Our goal is efficient and high quality care. We use immediate and objective information to diagnose and treat injuries rapidly.  

How we are different:

We triage patients using our proprietary MDDirect Orthopedic Solution and get them to one of our musculoskeletal experts in 24 hours.  These experts are orthopedic surgeons with over 30 years of experience.

We are seeing dramatic results reducing employers musculoskeletal claims. Real cost savings that employers and employees can see in their bank accounts.  

This is just a small part of getting better musculoskeletal care; getting to the right clinician. We will discuss next in part 2 how incentives motivate clinicians and the impact the care we all receive.

And in part 3 we will define high quality care, outcomes, claims data and how it all comes together.