Rising Interest in Virtual Second Opinions

By Matt Phillion

A new survey from The Clinic by Cleveland Clinic has found that virtual second opinions are a largely underutilized option for reducing high-cost care, improving clinical outcomes, and closing access gaps, particularly for patients with rare conditions. The survey found that:

• 95% of physicians support second opinions, but 70% hesitate to recommend virtual second opinions if it would mean out-of-pocket costs to the patient.
• Only 28% of physicians regularly recommend virtual second opinions, often due to lack of awareness or entrenched referral patterns.
• Oncologists lead the adoption of virtual second opinions at 52%, offering a model other specialties could look to.
• 67% of virtual second opinions recommend a diagnosis or treatment plan change.
• Virtual second opinions end up saving an average of $8,705 per patient after the initial investment, and an average of over $100,000 for high-cost cases. This comes primarily from avoiding unnecessary surgeries and reducing hospitalizations.

Opportunities exist for provider networks, health plans, and health system executives to close the virtual second opinion gap—but where does that process begin?

“The primary thing is awareness, across the patient population but also across the physician population,” says David Peter, MD, MBA, chief medical officer at The Clinic by Cleveland Clinic. “When you look at virtual second opinions, it’s a relatively new thing. Much of medicine is local and regional, but it’s important to stress that there are many cities and counties that have limited access to high-end specialty care, academic medical centers, and the like. Virtual second opinions can significantly fill that gap.”

In fact, the technological side of virtual second opinions is unequivocally there, Dr. Peter explains.

“In our personal lives, we’re using all kinds of virtual interactions, whether it’s work, family. I don’t know that a lot of good came out of the pandemic, but one of those was a relative comfort for many patients with using virtual medical care.”

This comfort level is felt on the physician side as well.

“It’s reasonable to say that 28% of clinicians have used virtual second opinions, and that’s actually a pretty high number. It sounds low compared to the 95% who say they would seek or assist with getting a virtual second opinion, but 28% is pretty good for a penetration rate,” says Dr. Peter.

Even if you’re surrounded by specialists, Dr. Peter notes, there are actually two kinds of healthcare deserts.

“One is simply you don’t have those specialists in your area,” he says. “But the second is more subtle: you have the specialist, but in a very limited number, which can cause a prolonged wait time.”

For example, if you have an older family member who has begun to show signs of cognitive decline, neurology is a specialty that faces a relative shortage of practitioners, leading to wait times in which four to six months is not unusual.

“It’s that combination of: do we have specialists in the area and, based on the density of the population, do we have enough of that specialty to serve that number of patients?” says Dr. Peter. “Folks like endocrinologists, neurologists, rheumatologists, specialists who treat complex conditions can be hard to find.”

Barriers beyond technology

One particular challenge facing virtual second opinions is the way regulatory constraints come into play.

“During the pandemic there was some relaxation of the rules around telehealth that allowed for more liberal use of virtual visits, but those have been restored to pre-pandemic levels,” says Dr. Peter.

The goal is for virtual second opinions to be available to any patient nationwide.

“That’s a national challenge and there are multiple groups working toward it,” says Peter. “I think it’s a matter of time and getting folks on the same page, and that the challenges are really an opportunity. In the meantime, we’ve strategically invested in expanding physician licensing to support more patients across more specialties of care.”

While there isn’t one particular technology that offers a panacea for solving all of the challenges of virtual second opinions, the options continue to expand and grow.

“We’re continuously improving. If you think about the full range of processes that go into delivering a second opinion of any type, all of those areas can be made more efficient,” says Dr. Peter. “Simply needing to see a specialist is not easy to navigate, whether it’s issues of finding one or setting up the appointment, and then there’s insurance and payer issues that need to be navigated. We’re focused on making that ease of access possible.”

While a number of companies are trying to lead the charge in opening up access to virtual second opinions, large academic medical centers, physician groups, specialist groups, and more are saying that this is a better way to serve more patients, Dr. Peter says.

“It offers a way to make this care more accessible,” he says. “Physicians just need the vehicle to get there. I cannot say without exception, but almost without exception physicians are doing virtual visits and consults even today, and I think there is an opportunity to incorporate this better.”

Who most benefits

Imagine a patient facing a new complex diagnosis, Dr. Peter explains.

“What if they’re looking at a life-threatening diagnosis or a very rare disease, those instances where there’s really high levels of specialization across the U.S. but in relatively small pockets? There may only be one or two or three experts in a region or even the country,” he says. “Having access to those specialists and being able to provide reassurance, peace of mind, accurate diagnoses, additional feedback on workups, or treatment all has a lot of value.”

In this vein, one group that is already seeing high utilization of virtual second opinions is oncology.

“Cancer treatments are changing daily,” says Dr. Peter. “Everything from new immunotherapy options, clinical trials, even things that have become mainstream that weren’t being utilized just two or three years ago. Within medical oncology physicians have developed a relative comfort reaching out to colleagues, specialty centers, or individuals who are going to have that most cutting-edge knowledge and who will be able to apply that to their patient’s care.”

Similar opportunities await in areas like complex cardiac care, complex neurological care, spinal surgery, areas of high specialization that may not be readily available face to face.

“Clearly, it starts with access to those specialists. Many of these fields are changing so rapidly that even an outstanding physician can’t be aware of all the changes, advancements, or opportunities at any given time,” says Dr. Peter. “Having access to experts who really care out those areas of specialty—such as a single, specific or rare cancer—reaching an expert who deals in that area on a regular basis has value to the physician seeking a second opinion, to the patient, and it may in fact change the therapy dramatically based on the most recent evidence.”

It also provides a chance to drive down costs. Where previously, the only way to get that second opinion would be to travel to that location, possibly for several days, it is now possible to see someone virtually, get to their full medical record, review necessary imaging, all from afar.

“The advantage of a virtual second opinion is you’re not just connecting the patient to the specialist,” Dr. Peter says. “You’re delivering their medical record, imaging, case studies, everything that’s been done up to that point, and you can ask the patient and their physicians the questions you need answered as part of that virtual second opinion. You’re not just seeing that specialist, you’re providing that specialist all the information they need to form that second opinion.”

It’s fascinating, Dr. Peter notes, that the industry was already doing this sort of work. It’s just becoming increasingly common, mainstream, and accessible.

“This tech has been available for quite a while, but there is a higher level of comfort and utilization with virtual care,” he says. “The most exciting part is imagining how the individuals and experts in your hallway just expanded dramatically. We can bring world-class care to almost anywhere in the world at this point.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.