Do Second Opinion Reads Need Different Reimbursement Formula?

The value of second opinions for patients is undeniable. Second opinions for breast cancer imaging are often referred to National Comprehensive Cancer Network (NCCN) – designated centers, and these centers receive thousands of second opinion requests annually. A multidisciplinary tumor board (MTB) at an NCI-designed center revealed that the diagnosis changed for 43% of the patients referred for a second opinion of breast cancer imaging.

A recent study published in the Journal of the American College of Radiology reveals that furnishing second opinions on breast imaging exams significantly raises workloads but radiologists are not generally adequately compensated. The research was led by Dr. Catherine Tuite of the breast imaging unit of the Department of Radiology at the ChristianaCare Helen F. Graham Cancer Center and Research Institute in Newark, DE.

Dr. Tuite’s team analyzed data over three years from 2015 through 2017. A total of 2,216 breast cancer studies were reinterpreted. They estimated that from 3,135 to 3,804 wRVUs were utilized during the study period for that specific CPT code. Yet, the credits received for outside reads were only 385, 375, and 345 wRVUs, respectively.

The researchers noted, “Practices such as crediting only the wRVUs for the lowest-value examination interpreted or assigning an arbitrary and highly discounted value not only significantly undervalue the work and time effort involved but also devalues the intellectual contributions and expertise of that physician.”

Second opinions don’t just confirm the findings of the previous radiologist. The radiologist must examine all imaging studies as if they were the primary interpretation. Preparing a formal second opinion requires substantial work from both radiologists and staff. In addition, more liability is involved when delivering a second opinion.

The reviewers noted, “Second-opinion interpretation of breast imaging studies adds value to a radiology department and institution by enabling downstream services for the care of new patients; this added revenue may help offset costs.”

But the study points out that their study might be valuable in developing a consensus on the most applicable reimbursement fees for second readings. Second opinions are of critical importance and directly influence patients, their diagnosis, treatments, and outcomes.