Radiologists often aren’t credited for 2nd opinion reads, despite the increased workload
When outside facilities submit requests for second opinions on breast imaging exams, workloads substantially increase at cancer centers, yet the effort involved is not reflected in the reimbursements radiologists receive.
National Comprehensive Cancer Network-designated centers receive thousands of such requests on breast imaging every year, and up to 43% of those referrals result in a new or differing diagnosis than what was stated on the original read.
Second opinions are clinically valuable, but they represent a substantial amount of extra work for radiologists.
“The breast radiologist providing a second opinion must interpret all the imaging studies as if he or she were performing the primary interpretation; merely confirming the findings of a prior interpretation is insufficient, especially as expert opinion may significantly change management recommendations or result in a new cancer diagnosis,” corresponding author Catherine M. Tuite, MD, with the breast imaging section of the Department of Radiology at ChristianaCare Helen F. Graham Cancer Center and Research Institute, and colleagues explained.
Radiologists also take on more liability when issuing a second opinion, which increases their risk of being involved in medical malpractice claims. All this combined has caused experts in the field to question reimbursement practices pertaining to second opinions.
However, the exact value of such effort has yet to be universally established. This is what led experts to dig deeper in an attempt to quantify the effort involved compared to the credit received when radiologists complete second opinions.
Utilizing data spanning three years, researchers conducted an analysis of reports for “outside film review.” In total, 2,216 studies were reinterpreted. The calculated range of annualized work relative value units (wRVUs) per specific CPT code was 3,135 to 3,804. However, for the years of 2015, 2016 and 2017, the credits received for outside reads based on the number of patient requests fell short at 385, 375, and 345 wRVUs, respectively.
“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,” the authors wrote.
Tuite and colleagues believe their results support study-specific professional fees being billed and credited to the interpreting radiologist. However, further discussions are needed to determine appropriate crediting and reimbursement, they added.
You can view the detailed report in the Journal of the American College of Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.