‘Cause for concern’: Unread second opinion reports cost one radiology department tens of thousands

Second opinion radiology reports often improve diagnostic interpretations and patient care but, when they aren’t read, can cost imaging departments tens of thousands in wasted resources.

In fact, one tertiary care center in the Netherlands found these unread reports resulted in more than $63,000 in losses, along with upwards of 130 hours in wasted rad interpretation time over one year. And authors of an Aug. 12 study believe nationwide figures would “substantially” raise those totals.

Co-author Sabine A. Heinz, and colleagues at University Medical Center Groningen’s Department of Radiology believe the problem can be remedied, but not until it is carefully analyzed.

“This potentially reversible waste of healthcare resources is cause for concern,” the authors wrote Wednesday in the American Journal of Roentgenology. “Our study has exposed the nonnegligible magnitude of this issue; therefore, it should be taken seriously by healthcare policymakers, including governmental bodies and insurance companies.”

Second opinion readings are on the rise, with rates in the U.S. jumping from 4.3% to 35.7% between 2003 and 2016, the authors noted. Heinz et al. found that at their practice, reinterpretations have skyrocketed by 150% over the past five years.

Wanting to know how often these documents are read, the authors retrospectively analyzed 4,696 rereads of outside imaging exams commissioned by subspeciality rads at the Dutch facility.

Of that total, 537 fell by the wayside, for a frequency of 11.4%. Heinz et al. estimated these unread reports cost up to $63,375 and about 134 hours of radiologist interpretation time.

“Although these numbers appear modest, they pertain to a single institution during a one-year time period,” they added. “Cumulative nationwide figures would raise these totals, possibly substantially.”

The researchers also looked at why these reports weren’t being looked at. Of the five independent variables they found, inpatient status was the top reason. Heinze and colleagues said these second-opinion reports were often not considered vital for decision-making.

Additionally, exams performed via sonography, those with neurology as the requesting specialty, and interventional radiology as the authorizing radiologists’ subspecialty were more likely to go unread. Reinterpretations requested by surgical specialties, meanwhile, were more likely to be looked over by a clinician.

“In conclusion, clinicians do not read a considerable proportion of second opinion reports, a situation that can be regarded as an appreciable but potentially reversible waste of healthcare resources,” the authors wrote. “If subspecialty radiologists and clinicians take proven determinants into account, the amount of second opinion readings with limited additional clinical value may be reduced.”