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Science


Grand Rounds, which delivers medical second opinions through its website and apps, will unveil a new service on Thursday offering quick case reviews during medical emergencies.

When a patient is wheeled in with chest pains or injuries from a car accident, he or his family can use Grand Rounds STAT to have a top doctor review the file, X-rays and medical history before the local team goes ahead with an invasive procedure.

“Within a short amount of time, usually less than an hour, you’ll have on the phone a world-class expert to connect in real time and consult with the doctor in the emergency room or ICU,” said Owen Tripp, the company’s co-founder and chief executive.

Owen Tripp, CEO of Grand Rounds

Courtesy: Grand Rounds Owen Tripp, CEO of Grand Rounds

The “medical intervention” service is available in the middle of the night or halfway around the globe, “24/7/365,” Tripp added.

The philosophy of the San Francisco startup, founded in 2011, is that much of the wasted spending in health care has nothing to do with the high price of drugs or medical procedures. Rather, it’s that many diagnoses are simply wrong and a lot of procedures are unnecessary.

It might be because the doctor’s training is out of date — or it could be because he or she just isn’t that good. Other times it may reflect misaligned incentives in the system. As Tripp notes, surgeons get paid to perform surgery, not to recommend physical therapy, even though the latter might well be the most effective treatment in many cases.

There’s also a general lack of transparency in the medical field. We pick doctors because they’re in-network, near our homes or recommended by a colleague. We have little insight into how their outcomes, prices and performance actually stack up against their peers. (For another interesting take on that problem, see insurance startup Oscar.)

Grand Rounds, which has raised $11 million to date from Venrock and Harrison Metal, has assembled what it describes as a network of the top 0.1 percent of medical experts across a wide range of specialties. They’ve culled the list based on university pedigree, publication history, medical outcomes and ratings by other doctors.

Patients can tap into that knowledge using the company’s Expert Opinion service, allowing another set of eyes to review their histories, diagnoses and treatment plans. When appropriate, they suggest alternative approaches. The process occurs online or through mobile apps.

More recently, the company launched Office Visits, which points patients to local specialists that they can actually visit in person.

Grand Rounds markets the system to employers — particularly self-insured ones that cover employee medical costs directly — on the bet that they’ll save the companies’ money. In fact, they bet they’ll save them a lot of money by avoiding unnecessary procedures or more rapidly arriving at the correct treatment plan.

Twenty-five enterprise companies use the product today and Grand Rounds experts recommend major changes in diagnoses or treatments about 65 percent of the time, Tripp said.

“That means that the majority of cases we’re looking at are getting care that is less than exemplary,” he said. “If that doesn’t terrify you, I don’t know what does.”

Avoiding just a few unnecessary surgeries adds up quick. Tripp said they see savings of $10,000 on average per case that works its way through Grand Rounds.

“You lower the cost to the system because you get medicine right the first time,” he said.

The obvious critique is that this is a way for companies to nickel and dime their employees on health care. You can bet that patients ready to pursue an expensive treatment recommended by their trusted family doctor will be dubious of a second opinion that happens to conform with their employer’s financial interests.

But Tripp said the consulting doctors get paid the same no matter what conclusions they draw. Moreover, they’re rated on outcomes and the opinions of their peers.

“Their only incentive is to do right by the patient,” he said.




1 comments
StarlingCurve
StarlingCurve

This is a dangerous business model.  An acute heart attack in the ER can have less than a one hour margin between treatment and death.  Some web site second guessing emergent treatment will have some negative consequences for some.

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