Why Not Every Hospital Should Consider a Virtual Second Opinion Program

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Medical second opinions are fast becoming a standard patient request as a part of a critical diagnosis. Medicare encourages patients to receive a second opinion before a life-changing treatment or invasive surgery. Malpractice insurance carriers encourage second opinions to lower their risk. The Cleveland Clinic reported that the market for second opinions is expected to more than double from 2019, reaching seven billion dollars by 2024.

There is good reason. Several studies, including this study from the Mayo Clinic, found that an overwhelming percentage of “first'' opinion diagnoses and treatment plans ended up modified as a result of a second opinion; some 20% change entirely. And even when the initial diagnosis and treatment plan is affirmed by a second opinion, patients are comforted that their current treatment plan is indeed the right choice.

An increasing number of hospitals market in-person second opinions which are little more than an additional physician visit.  A small but growing number of innovative institutions now offer second opinions entirely online. These are often called remote or virtual second opinions. Different than an in-person exam, a virtual second opinion does not involve a face-to-face medical exam. Rather than the patient traveling to yet another medical appointment, the remote physician restricts his or her review to the patient’s existing test results, scans, biopsies, exam notes, and diagnoses. 

Virtual second opinions are a great way for a hospital to expand its reach beyond the limits of its physical walls and local geography. By providing a remote second opinion, the reviewing physician, often an expert in his or her field, and hospital are often the patient’s choice for a required procedure. But offering a virtual second opinion requires a clear intent, investment, and mindset that is not appropriate for every healthcare institution.

Online Second Opinions are Not as Good as an In-Person Examination

We’ve run into plenty of physicians who don’t feel comfortable issuing a medical opinion without examining the patient in person. They are likely the same population that thinks that telemedicine is a fad.

But, telemedicine has shown to have clear benefits. While not perfect for every situation, there are a subset of situations in which a telemedicine visit is better than one in-person. If you didn’t realize this already, you likely found this out during the recent pandemic. 

Online second opinions are a bit different than telemedicine and often are the next logical addition to your telemedicine strategy. The advantage that a virtual second opinion has over telemedicine is that it is generally performed asynchronously.  That frees your busy physicians from having to add another appointment to their already overbooked day.  Instead, they can perform virtual second opinion reviews on their own schedule, at times that are most convenient.

Remotely situated patients love the idea of not having to make that trek to your facility unless and until it is required. Patients can reduce exposure to disease and avoid inconvenience and cost of travel. They can tap the knowledge and expertise of the finest specialists no matter where they live. Payers love remote second opinions because they reduce the cost of duplicate exams and often identify more effective or less invasive procedures. And, as we previously found, physicians love them due to their flexibility.

A virtual or online second opinion does restrict the physician’s review to the existing patient medical records and test results - scans, test results, and prior physician notes, all performed by someone else. To those who must see a patient in person in order to render an opinion, online second opinions are not for you.

Online Second Opinions are Typically Not Reimbursed by a Patient’s Health Insurance 

If you are going to offer an online second opinion, in most cases you will need to rely on either patients paying out of pocket or one of the charitable grant organizations, like the Mike Shane Fund, that subsidizes the cost of second opinions. 

We expect that sometime in the not-too-distant future, online second opinions will be reimbursed at a level equivalent to in-person visits. While Purview and others are actively advocating for this, we are not yet there.

If your financial model is built expecting health insurance to cover these second opinions, do not begin a virtual second opinion program.

If You Build it, They May Not Come

Just because you set up a virtual second opinion program does not mean it will be an instant success. No matter how well known your brand is, prospective patients’ awareness that this program exists is key. If you are not prepared to invest time and resources promoting your program, its benefits, and the specialties it covers, both within and outside your organization, don’t invest in an online second opinion program.

Physicians Not Licensed in Other States Can’t Issue Opinions There

Your largest audience for second opinions is located outside of the state in which your facility is located. Physicians, however, are licensed on a state-by-state basis. If a physician in your organization is not licensed in a state from which the patient requests a second opinion, your legal team will be called upon to decide if this is appropriate. In order to render second opinions in those locations, you will need to find ways to get past this constraint. 

The best practice adopted by most successful second opinion programs is to offer your opinions as educational content and to require a physician local to the patient with whom the second opinion is rendered to be involved. In just about every jurisdiction, patient education, as well as a physician-to-physician consult, are considered legally acceptable even across state boundaries. Similar issues occur when offering such a service to patients in other countries. 

We’ve seen legal departments that can’t overcome this indigestion. If yours can’t be convinced, don’t plan on moving ahead with a second opinion program.

Free Webinar: Second Opinion Licensure Discussion with the Experts

Doctors are Already Too Busy

We know that physicians are busier these days than ever. Asking them to take on yet another task during their day may be an imposition. So why would they agree?

Most successful second opinion programs encourage but don’t require their physicians to participate. Enterprising physicians often see a second opinion practice as a way to extend their own personal brands, expertise, and value well beyond the four walls of your hospital. Some may be enticed by a stipend paid for completing a second opinion.

If you don’t believe your physicians will be interested or if their reluctance will be overly burdensome, then you might want to reconsider a virtual second opinion program.

A Small Market Geography Won’t Sustain a Second Opinion Practice

If your hospital is not located in an NFL city, your administration may be reluctant to promote a second opinion practice. What might not be apparent is that you likely already have a subspecialty or two that stands out amongst your peer hospitals. Highlighting one or more of these specialty practices or physicians is exactly how you can get started to extend your reach beyond your local geography.

You might note that institutions like the Cleveland Clinic (ranked #1 by US News and World Reports), while in an NFL city, has leap-frogged many of its big-city rivals by extending their expertise well beyond its local geography. If you weren’t already aware of the brand the Cleveland Clinic has established, you probably would not have bet that a hospital in Cleveland, Ohio could build a reputation beyond those in cities like New York or Los Angeles.  Obviously, they have. And it may be no coincidence that their virtual second opinion program, dubbed “The Clinic,” is the largest and most mature of its kind anywhere.

If your future vision is limited by your current small market geography then don’t try to stand up a second opinion program.

Your Budget Doesn’t Warrant an Investment in a Second Opinion Program

In the world after COVID-19, hospital finances have taken a beating. Staff are overwhelmed, wages are accelerating and the future is still uncertain. Hospital CFOs are clamping down on unnecessary expenditures, avoiding anything other than what is critical. Your virtual second opinion program may get left out.

Virtual second opinion programs require an investment. Often the fee patients are charged for a second opinion barely covers its incremental cost. Remote second opinions will make the hospital rich. However, the goal of a successful virtual second opinion program is to extend your hospital’s brand to both attract more patients who might not have otherwise considered your facility as well as to convert some of these second opinions into patient procedures. Successful programs generate incremental revenue and profits that provide a great return on your investment. Conversion rates for excellent programs can range as high as 20% of second opinions turning into procedures. That can amount to millions of dollars of highly profitable extra revenue for your facility. But it takes some time to reach this level.  

If you are not able to convince management that the required up-front investment is warranted, then don’t proceed with a second opinion program.

If You Don’t Someone Else Will

The beauty of second opinion programs is that they can be marketed anywhere (with an internet connection). Despite the size of your institution or its geographic location, you can begin to attract new patients from virtually any geography. But this access is a two-edged sword.  If you can, so can a competitor. 

Your decision whether to pursue a virtual second opinion practice may be driven by these competitive pressures. One hospital we recently worked with decided to jump into the virtual second opinion business just to ensure it did not lose patients to its competitor.

While the defense of your market alone may not be a sufficient reason to consider a virtual second opinion practice, the market will eventually vote with its wallet. What you probably want to avoid is being the only hospital with your specialty to not be offering an online second opinion practice.


Just like any other new opportunity, a virtual second opinion practice is not right for everyone. However, it has great promise and similar rewards for those who are realistically prepared to make the program a success.

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