Radiology department launches ‘financially viable’ 2nd-opinion service, ditches ‘curbside consults’

A pediatric hospital has launched a “financially viable” second-opinion service to help outside institutions interpret images, and it is ditching time-consuming “curbside consultations” that do not receive proper pay. 

Texas Children’s Hospital experts detailed their efforts Jan. 30 in the journal Current Problems in Diagnostic Radiology. The Houston institution initiated the service in 2016, billing for formal second-opinion interpretations across MRI, CT and nuclear medicine. 

Customers are commonly referrers dealing with questionable imaging findings for which a pediatric radiologists’ second look will drive decision-making. In 2020, the service handled nearly 3,500 studies from over 2,500 patients. This amounted to about 4,700 relative value units (RVUs) during the study period—equivalent to the work of one full-time radiologist in the department. 

“Our findings indicate a formal second-opinion interpretation program can be financially viable and may help offset the additional resources required,” Victor J. Seghers, MD, PhD, division chief of community radiology at Texas Children’s, and co-authors concluded. “Hospital administrators and radiology department leaders should consider these data when making decisions about offering and staffing such services.”

Referrers submitted scans for a second opinion via the hospital’s image-sharing platform between January and December 2020. To receive a response, they must complete an online form, provide a brief clinical history and one of three reasons for the request. These include (1) potential impact on patient management, (2) questionable findings, or (3) the need for subspecialty expertise. Exams older than six months were not eligible for second interpretation, nor were ultrasounds, fluoroscopy exams or X-rays “due to variability in techniques and the operator-dependent nature” of such studies.

Of the 3,485 second-opinion exams logged in 2020, about 17% (or 596) were not charged to an insurer and, instead, considered free care, investigators discovered. Once uploaded by the ordering provider, film library staffers verify each study and send it to the PACS, creating a unique identifier (or “accession” number) and imaging code. Among the 2,889 studies that received payment, 34% (or 986) represented multiple accession numbers per patient per day handled by the same radiologist. 

“Due to the method studies are accounted for in the revenue department database, reimbursement for these multistudy exams do not have a direct linkage with studies read, and were excluded,” the authors wrote. 

Of the 1,903 that qualified, patients were an average age of 11 and 46% were female. Most were CT (88%) and typically covered the body (988) and neurological concerns (660). About 9% were classified as self-pay, with the patient having no insurance or failing to meet their deductible. Of these, nearly 92% were unpaid and the total reimbursement rate (total payment/total charges) was 5%. 

The other 1,737 were submitted for payment of the professional fee only, for which the overall reimbursement rate was 36% compared to 41% for similar internal studies. About 190 outside studies submitted to insurance received no payment, equaling a denial rate of 11%. That’s compared to a 7% rejection rate across all internal studies. Texas Children’s requested reimbursement from 54 different health plans for these second reads. This included 743 submissions to 14 private payers and 994 to 40 different government insurers. Average reimbursement per study from commercial payers was 52% versus 23% for government payers. 

The authors believe this is one of the first analyses to examine RVUs stemming from a pediatric secondary interpretation service. They hope their findings help guide hospital leaders looking to take on this work. 

“Particularly in academic medical centers, increases in clinical workload have been shown to negatively affect the academic productively of radiologists, and the expanding workloads and production targets are known to contribute to burnout,” they advised. “Therefore, it is important that formal dictation of second-opinion reports occurs rather than ‘curbside’ consults which are nonquantifiable and nonreimbursable. Specifically, it is imperative that the additional work for second-opinion interpretations be appropriately documented and quantified for both resource allocation and compensation purposes.”

You can read more about the results, including potential study limitations in CPDR.