Should hospitals offer a remote second opinion service?
Second opinions are becoming an important component for patient healthcare. A recent study by the Mayo Clinic identified that as many as 88 percent of second opinions either differ to refine the original patient diagnosis . This occurs more often than not when the physician rendering the second opinion has specialized expertise in the field in question and has the benefit of careful review of the patient’s prior complete set of clinical data.
While these opinions are often referred to as second opinions, they may be the first subspecialty review of a complex patient exam. This is frequently the case when the patient resides in a more rural area that does not have a large density of specialists
in a particular clinical issue. They seek second or more specialized opinions from larger city facilities often focused on a particular subspecialty.
In the United States, as well as in other specific countries with advanced healthcare capabilities, second opinions are often sought by patients outside of their country’s borders. These often are patients who can afford both the cost of obtaining a second opinion without health insurance subsidy as well as the cost of travel to receive local treatment outside of their country.
It should be no surprise that the market for obtaining second opinions is growing steadily. In 2017 the worldwide recorded revenue for second opinions was about $2.25 billion . By 2024, this market is anticipated to be as much as $7 billion .
What do second opinions cost?
Fees charged for second opinions vary among hospitals that offer them. At the high end, they can range up to as much as $2,500. Typically, they average closer to $750. Since second opinions generally utilize existing fixed infrastructure and little incremental variable cost, when efficiently delivered, second opinions themselves are likely to generate a small profit for the hospital. Since patients often are required to pay for second opinions out of pocket, these fees are often collectable in full, avoiding diminution in value from pre-negotiated payers’ reimbursement.
There sometimes is additional revenue associated with a second opinion. If a second imaging read is required or a specialized pathology read is advised, these fees would be charged in addition to the set fee. Often these fees are payor reimbursable.
Generally, the impetus for developing this capability is not the value of the second opinions themselves. Two other more strategic and significant benefits accrue to the hospital that engages in the delivery of remote second opinions.
The first is growing the brand awareness for the hospital. Hospitals that offer remote second opinions may use this to promote its specialization beyond its local geography. Especially for hospitals that may appeal to more remote geographies, this may position the hospital in the minds of primary care and other local physicians when and if they require that expertise. The second and more immediate benefit is that if a patient procedure is required, the hospital rendering the remote second opinion is often the logical choice for that patient.
Certainly, in the current and post COVID-19 world, hospitals will be struggling to find sources of revenue to refill its depleted financial condition. With procedures averaging around $20,000, performing these for patients outside of their networks is a welcome increment to their ongoing operations.
Is there software available to automate the second opinion process?
The last thing a hospital wants to do is take on a new large administrative burden and the associated costs. Hospitals have historically turned to referral services to avoid taking on this burden. These services like GrandRounds or PinnacleCare offer to refer patients to the facility and handle the processing of the collection of patient data as well as the delivery of final reports.
Utilizing such a service has been an easy entry point for these hospitals. However, what results is a higher patient fee (this is where the high end of the fee range happens) and less control over the flow of inbound second opinion requests. Concierge or referral sources were a good alternative when no efficient software was available. But now with focused second opinion software available to ease much of the administrative burden, hospitals are more inclined to control their own second opinion destinies.
New second opinion software, like Purview’s Expert View, handle much of the associated administration. By utilizing a patient self-service front end, requests can come in without any human intervention. Patient release forms are completed electronically and prior clinical records are captured electronically from the sources that the patient or his or her treating physician supplies. Almost nothing needs to be mailed or faxed, including scans or pathology images.
Often physicians rendering remote opinions find it helpful to chat directly with the patient. Efficient second opinion systems include an integrated easy to use and secure video chat capability. It turns out under the current COVID-19 emergency in the US, additional fees may be covered by payors when physicians utilize real time video chat.
With this specialized software now available, it is now more appealing than ever to consider establishing a second opinion function with your hospital. For more information on the fundamentals of how to establish your own second opinion function, check back with this blog for our next installment.
 Science Daily, April 4, 2017, The Value of second opinions demonstrated in study
 Industry Analytics Research Company, Medical Second Opinion Market – Forecast (2020-2025)