Are Remote Second Opinions an Option in Orthopedics?

Earlier this year, I injured my hand during a martial arts training session; I heard a popping noise at the same time that I felt a lightning bolt go through my finger. Ouch! Later that hour, I was in an urgent care center getting an x-ray taken of my hand. Working for a cloud-based medical records company, I figured that a doctor would need to see my scans someday, so I asked the x-ray technician how I could get my images to my provider. He told me that he can burn a CD for me and I can take it to my visit. Easy enough.

Fast forward to a couple of weeks later. I saw a sports medicine doctor near my home and remembered to bring the CD with me. The physician took a look at my images in another room, asked me some questions, and after some painful hand manipulation, he told me that I have a sprain on my metatarsophalangeal joint in my finger. He recommended that I use some buddy tape for a few weeks and make a follow up appointment if it still hurts. Six months later, my hand is practically back to normal and of course, I’m back in martial arts.

I was fortunate enough to be able to travel to multiple locations to get imaging done and have an in-person examination. Some people don’t have it that easy. Other patients may live in rural areas, do not have insurance, or perhaps suffer a much more serious injury such as chronic nerve condition or need to have their joints replaced. Traveling would be a pain (literally)!

A real X-ray of my hand - viewed in Horos, a free DICOM viewer for Mac computers

When it comes to orthopedic second opinions, the goal is often to receive confirmation that surgery is the best treatment option. Patients may be seeking alternative, less invasive treatment options, or more specialized experience. 

These days, telehealth is becoming a household name. Patients are receiving care remotely, hospitals are creating programs to reach more patients, generating new revenue, and doctors are looking for ways to push the field of medicine forward. The entire healthcare industry saw stunted growth in elective surgeries during the early stages of the pandemic, and orthopedics was no exception. As we return to ‘the new normal,’ telehealth is emerging as a tool to engage new patients.

Healthcare returns to its former glory?

According to an article regarding the future of US healthcare written by McKinsey & Company, “Healthcare industry EBITDA grew 5 percent pre-COVID-19 (between 2017 and 2019) and remained flat over 2020 and 2021. We estimate post-COVID-19 (between 2021 and 2025) growth at 6 percent…”. 

Sherry Wren, MD, professor of general surgery at Stanford Health Care, shared her thoughts in an article published by Stanford Medicine regarding their 2021 research study: "The majority of surgeries in the United States can be performed on an outpatient basis, so many surgeons could operate without filling up inpatient beds," she said. According to the article, “...there was strong financial pressure for hospitals to reopen their operating rooms” due to surgery being a large revenue source.

To lessen the burden of halted elective surgeries on the bottom line, institutions looked to diversify their revenue streams by implementing new programs including online second opinions. However, entities are continuing to encounter age-old inefficiencies such as cumbersome access to patient imaging, administrative overhead, and delays in communication as these new programs are being rolled out.

Remote Second Opinions - Quick and convenient, BUT Out of Pocket

A UC Irvine study published by Surgical Neurology International shows that second opinions often deliver results a week faster than an in-person second opinion, but at an out of pocket cost to the patient:

“The cost of the second surgical opinions averaged $493 (±$343) USD (range $90–$1,300); the time to receive a second opinion averaged 20 (±19) days (range 1 day–5 months). Remote or “online second opinion” programs charged an average of $643 (±$259) USD (range $100–$850), and the time to receive an “online second opinion” averaged 14 (±7) days (range 1–4 weeks).” 

For some, this cost is still less than the cost of travel, and worth it for the added convenience. But for others, paying out of pocket is simply not an option. Today, reimbursement has yet to catch up with telehealth services. Equity issues surrounding access to wifi, devices, and payment are concerns that must be addressed to see mass adoption.Stanford Medicine Online Second Opinion Program’s website states: 

“Currently, most health plans do not cover online second opinions or consultations, so patients are responsible for the cost of the second opinion.”

The Process

You may be wondering how telehealth tools can support orthopedic services when many physicians prefer to see patients in-person. First, it's important to note that these services do not work for everyone and for every type of case. Some cases can only be evaluated in person, but for some with existing records, they may be appropriate for a partial or entire remote consult. For the right patient and case, it can save everyone time and money.

For example, in some orthopedic second opinions, the provider may want to see the patient’s medical imaging studies first. This way, they can provide a quick read prior to having the patient come in for a full evaluation. If the patient is not a good candidate for surgery, or their medical issue falls outside of the physician’s expertise, the quick read can provide direction for next steps without wasting valuable time or forcing the patient to travel. Alternatively, the second opinion could provide recommendations the patient can explore ahead of surgery, or time to coordinate treatment, all from the comfort of their home. Dr. Stephen James, an orthopedic surgeon, recently explained this process to Purview, recounting how often his patients are in severe pain by the time they are ready to explore surgery. Being able to coordinate care and explore options from the comfort of their home is a major advantage when attracting new patients. 

Technology plays an important part in facilitating a provider’s ability to communicate and work with patients remotely. Since access to prior medical records such as imaging studies, is often a prerequisite for a second opinion, delays in the acquisition or lack of access to imaging can bottleneck the process entirely. Cloud based platforms that enable patients to ‘self-serve’ or easily enable access to past medical records is an important part of this process. 

Collecting fees for second opinions can differ depending on the situation. In some cases where commercial insurance is available, the fee would be billed. As noted, insurance generally does not cover online second opinions. So in most cases, the fee is typically collected up front. Although it’s worth mentioning that some orthopedic surgeons choose to offer a quick read and opinion for free when patients are exploring whether they want to travel for a surgical procedure. In these cases, the facility makes up any revenue lost for providing the initial read in the revenue and profits generated from the procedure.

Economic Outlook

“Vantage Market Research forecasts the sector to expand 4.7% annually over the next six years, swelling from $42.1 billion in 2021 to $55.4 billion in 2028.”  Orthopedic Design and Technology

Regarding second opinions, “...the global medical second opinion market size is expected to reach $10.73 Billion by 2027 from $3.20 Billion in 2019; it is estimated to grow at a CAGR of 16.8% from 2020 to 2027.” The Insight Partners

In a post-pandemic society with an uncertain economy and shifting healthcare practices, the hope for these entities lies in their ability to attract and retain patients. The advent and adoption of telehealth has improved communication speeds, accessibility to medical records, elevated customer satisfaction levels, and expanded the reach of institutions entirely.



Want to learn more?
Register for Purview's webinar 'The Special Case of Orthopedic Second Opinions'
Read: Remote Second Opinions, A Cure for the C-Suite Blues
or reach out to us to learn about Purview's second opinion platform, Expert View




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