Hospital redesigns radiology 2nd opinion service, scoring 92% collection success rate
Imaging leaders are detailing how they redesigned their hospital’s radiology second opinion service, helping boost both physician satisfaction and reimbursement.
Seeking an outside assessment from a different institution’s radiologist often is essential in imaging—whether to address discrepancies or answer unresolved clinical questions. While sometimes lucrative, these outside consultations can come with potential pitfalls such as insufficient documentation, miscommunication, and the risk of repeat imaging or even medical malpractice. The Ohio State University Medical Center, Columbus, has worked to address these challenges, standardizing workflows for second opinion consults, according to new research published Tuesday.
They’ve achieved early success, including a 92% collection rate for outside reads while also optimizing efficiency and improving patient care, experts wrote in the Journal of Imaging Informatics in Medicine.
“The promising collection rates, enhanced user-friendliness, and high satisfaction with perceived timeliness of reporting underscore the success of the new process,” lead author Akhil Dhamija, MD, MBA, with OSU’s Department of Radiology, and colleagues concluded. “Continued monitoring and refinement of the workflow will be essential to maintaining and further enhancing these positive outcomes,” they added later.
To address inefficiencies in the second-opinion services, OSU made several updates. This started with automating the importation of outside imaging studies using a reconciliation tool, which “harmonizes” patient identifiers and links studies to the appropriate patient chart. A second-opinion order is then placed, with reading room assistants monitoring a work list for requests, ensuring they meet departmental criteria. These standards include whether (1) an outside report is available for radiologist review, (2) an indication that clearly states medical necessity for a second opinion, and (3) outside imaging was performed within a certain timeframe. Initially, this figure was 30 days during the pilot phase of the project, which subsequently extended to three months.
“Once these steps are completed, the study automatically populates a specialty-specific radiologist work list, and the reporting process is conducted similarly to in-house studies, using the same reporting software and reporting templates to document findings as those for studies done at our institution,” the authors wrote. “Using standardized reporting templates and having an indication of medical necessity for the second opinion together allows for the original work relative value unit (wRVU) of the CPT code of the outside study to be documented and used for billing.”
Ohio State University Medical Center initially rolled out this new system in August 2021 for all divisions except breast imaging, which has a separate workflow for second opinions. After early success and fine-tuning, they further expanded the service from one-month-old to three-month-old exams in April 2022. Dhamija and co-authors analyzed data on the impact of these changes during the 14 months ending in October 2022. They also surveyed both radiologists and referrers to gather feedback about the changes.
The final sample included 617 second opinion reports. Of those, about 90% were successfully reimbursed, 9% were labeled as “instances of failure to reimburse,” and for less than 2% “no charges were recorded.” This resulted in a reimbursement success rate of 91.9%, and overall collection rate (amount collected with respect to total billed, considering institutional contractual agreements) of 36%. Exams OSU was unable to collect payment for were primarily because they lacked the necessary authorization (57%). Another 33% stemmed from issues related to deductibles or self-pay situations.
OSU’s abdominal division accounted for about 47% of second opinion exams, followed by neuroradiology (26%), chest (17%), nuclear medicine (9%), and MSK (1%). Meanwhile, the most-used modalities included CT at 64% followed by MRI (26%), nuclear medicine (9%) and ultrasound (1%).
In surveys, participants reported improvements in user-friendliness, with “substantial” positive trends among ordering providers. Satisfaction with perceived timeliness of report availability also was high across both rads and referrers, and radiologists reported perceived improvements in efficiency. Ordering providers also expressed “strong” support for the workflow’s ability to reduce unnecessary imaging. Radiologists provided similarly positive ratings, the authors added.
The 92% reimbursement success rate was equal to figures recorded for regular internal imaging studies at OSU, signaling the program’s success.
“This was a promising result and allowed continued use of this process and maintained financial viability,” Dhamija and colleagues reported. “For continued success and additional process improvement, we realize that future efforts can be focused on improving authorization processes. Specifically, implementing more rigorous pre-verification protocols to enhance communication with referring providers, ensuring all necessary authorizations are secured before second opinion exams.”
Read much more in the official journal of the Society for Imaging Informatics in Medicine. The study is open access and does not require payment nor log-in information.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.