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In a rural town in the United States, Jordan’s infant son, Milo, was born with a cranial abnormality. Upon medical evaluation at their local hospital, the infant was diagnosed with craniosynostosis, a congenital disorder characterized by premature fusion of cranial sutures leading to a misshapen skull and potential brain growth restriction. Milo required major surgery to address his condition, but due to the scarcity of specialized healthcare services in their region, particularly for such a complex procedure, the family could not access the necessary medical expertise. Desperate for support, Jordan researched her son's condition and located a children's hospital with a top-ranked Craniofacial surgeon. Yet, the facility was nearly one thousand miles away from their hometown, and due to financial constraints, such as the cost of transportation, lodging, and time off from work, Jordan doubted their ability to make the trip across the country for the surgical evaluation. She worried that even if they could get there, what would happen if her son was not a good candidate for the surgery? It was not a realistic option for them to visit multiple hospitals in person to receive second opinions, and she felt stuck. Jordan’s story represents the struggle of many Americans to access quality medical care for their children without facing significant geographic and financial barriers. For this reason, many families seek answers closer to home, instead of receiving care from top experts, which can reduce positive healthcare outcomes.

The following paper is intended for informational purposes only and should not be construed as legal advice. The information provided in this paper is not a substitute for professional legal advice and should not be relied upon as such. Readers should always consult with a licensed attorney or qualified legal professional for advice on specific legal issues. The author of this paper and any entities associated with the author are not responsible for any actions or decisions taken by readers based on the information provided in this paper.

In the United States, it is well established that individual states and territories, rather than the federal government, regulate the practice of medicine within their borders. That means that unless there is an exception, a provider must be licensed in the state in which the patient is located in order to deliver a medical diagnosis or to prescribe treatment to a patient in a specific jurisdiction. The licensure process is burdensome and expensive, effectively impeding all but the most determined physician from seeking this legal authority to practice beyond his or her state’s borders.

Congratulations! Your institution has considered the countless benefits of offering a Remote Second Opinion (RSO) program, such as improved patient access and increased geographic reach. Your team is undoubtedly ready to jump into planning out the best program for your patients and providers. While it can be easy and exciting to visualize your RSO program helping patients, the process of getting to your go-live date can feel overwhelming. Your team may be asking big-picture questions such as:

“How do I start a Remote Second Opinion program?”
“What stakeholders need to be involved in the RSO implementation process?”
“How long will the implementation of my RSO program take?” 

Cincinnati Children’s Hospital Medical Center is globally recognized for their leading research, education and innovation in pediatric care. Consistently ranked as a top pediatric hospital by U.S. News & World Report in their annual Honor Roll, Cincinnati Children’s was most recently ranked as third in the nation in 2022. With second opinion programs emerging as a new channel for accessing specialty expertise from afar, Cincinnati Children’s has ensured that children across the United States can benefit from access to their widely acclaimed disciplines and physicians through their own online second opinion program.  

Demand for telehealth solutions has boomed over the past few years. Medicare telehealth visits alone grew from 840,000 in 2019 to 52.7 million in 2020, or 63-fold as shown right (source: Benesch Friedlander Coplan & Aronoff).

For cases deemed appropriate for telehealth, some studies have provided overwhelming evidence of increased patient satisfaction with remote visits compared to traditional in-person (urology; breast cancer; radiation oncology; general medicine). One of the main drivers? Convenience. Patients love removing the travel time and associated costs or tradeoffs that come with taking off work, finding childcare, and traveling to see a physician in person. Additionally, the CDC reports that 15%, or 49.8 million Americans live in rural parts of the U.S., which correlates with poorer health outcomes regardless of income level. Access to specialty carefor this population has been known to be especially difficult or impossible, but telehealth programs have introduced a new channel that many patients can take advantage of. 

In addition to increasing patient demand, there is a strong business case for Hospitals to expand their reach through telehealth modalities. A recent article by Purview's Dr. Christopher Schwartz, Remote Second Opinions: A Cure for the C-Suite Blues, describes the challenging financial state of many hospitals post-covid. Schwartz explains that, ‘during the lockdown alone, U.S. hospitalslost an estimated $22 billion in revenue due to cancellations in elective surgeries.’  Contrast this with the estimated value and market growth of the second opinion market at $10.7 billion by 2027with a CAGR 16.8%, and it is understandable why many hospitals are exploring the potential of these programs. Here, we outline key considerations for your organization as you assess readiness prior to launching a second opinion program.