{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T21:51:23Z","timestamp":1773697883108,"version":"3.50.1"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Goal:<\/jats:title>\n Consultations via commercial telemedicine platforms have enabled patients to access a larger network of providers whose secondary treatment recommendations may differ from those obtained by primary care providers. Subsequent changes in treatment recommendations may have meaningful implications for cost value and quality of care. However, despite the increased use of telemedicine, the frequency and type of treatment changes that occur are not well understood. This study evaluates the association between digital expert medical opinions (EMOs), treatment strategy changes, and cost implications, using data derived from a specialized musculoskeletal telemedicine platform.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Musculoskeletal EMOs from a large commercial digital health organization were retrospectively reviewed between 2020 and 2024. Treatment metrics, including surgical diversion (i.e., declining a surgical procedure), as well as the frequency of diagnosis and treatment plan changes, were calculated using existing client records and reports. Subsequently, an economic analysis was done to extrapolate potential cost savings based on treatment changes. Projections were constructed using average consultation cost savings based on Current Procedural Terminology (CPT) billing data and annual capture rates for a real-world enterprise client. Projections were also extrapolated to clients of various carrier sizes.<\/jats:p>\n <\/jats:sec>\n \n Principal Findings:<\/jats:title>\n Among the 544 musculoskeletal EMOs reviewed, 40.1% of consultations resulted in surgical diversion. More than half (53.0%) of treatment plans changed as a result of obtaining EMOs, while the diagnosis change rate was 22.5%. An average cost savings of $8,146.89 per EMO was estimated based on data from a current enterprise client. Extrapolation of this analysis to a medium-sized carrier (10,000 annual claims) and a large-sized carrier (30,000 annual claims) based on data from this enterprise client was estimated to be $754,558.44 and $2,263,675.33, respectively.<\/jats:p>\n <\/jats:sec>\n \n Practical Applications:<\/jats:title>\n Among secondary digital EMOs obtained through a telemedicine platform, more than half of treatment strategies were changed, with surgical diversion observed for 40% of patient cases. Resultant treatment and diagnosis strategy changes may result in increased value for patients, payers, and participating healthcare entities as demonstrated through the economic projections established using real-world data. Further extrapolation of savings based on claim volume, capture rate, and various client sizes may provide additional insights into the utility of telemedicine in other spaces as it pertains to defining appropriate treatment pathways and adjusting optimized costs.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/jhm-d-24-00256","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T05:00:30Z","timestamp":1767589230000},"page":"71-81","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Expert Medical Opinions Associated with Treatment Strategy Changes and Substantial Cost Savings for Healthcare Payers"],"prefix":"10.1097","volume":"71","author":[{"given":"Kyle N.","family":"Kunze","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spencer W.","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ally","family":"Bonnet-Eymard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinne","family":"Herz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten","family":"Smyth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedict U.","family":"Nwachukwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"issue":"1","key":"R1-20260316","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1186\/s12913-023-10405-x","article-title":"Cost-effectiveness of a second opinion program on spine surgeries: An economic analysis","volume":"23","author":"Antonioli","year":"2023","journal-title":"BMC Health Services Research"},{"issue":"6","key":"R2-20260316","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1093\/bjs\/znad004","article-title":"Cognitive biases in surgery: Systematic review","volume":"110","author":"Armstrong","year":"2023","journal-title":"British Journal of Surgery"},{"issue":"4","key":"R3-20260316","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/JHM-D-18-00077","article-title":"Delivering value-based care with e-health services","volume":"63","author":"Bauer","year":"2018","journal-title":"Journal of Healthcare Management"},{"issue":"1","key":"R4-20260316","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1357633X20919308","article-title":"Tele-orthopaedics: A systematic mapping study","volume":"28","author":"Behmanesh","year":"2020","journal-title":"Journal of Telemedicine and Telecare"},{"issue":"2","key":"R5-20260316","doi-asserted-by":"crossref","first-page":"v\u2013vi, 249\u2013257","DOI":"10.1016\/j.coem.2004.02.006","article-title":"Factors influencing the costs of workers\u2019 compensation","volume":"4","author":"Bernacki","year":"2004","journal-title":"Clinics in Occupational and Environmental Medicine"},{"issue":"9","key":"R6-20260316","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1097\/JOM.0b013e31816fd696","article-title":"The relationship between attorney involvement, claim duration, and workers\u2019 compensation costs","volume":"50","author":"Bernacki","year":"2008","journal-title":"Journal of Occupational and Environmental Medicine"},{"issue":"7","key":"R7-20260316","doi-asserted-by":"crossref","first-page":"e0236048","DOI":"10.1371\/journal.pone.0236048","article-title":"Outcomes of second opinions in general internal medicine","volume":"15","author":"Burger","year":"2020","journal-title":"PLoS One"},{"issue":"9","key":"R8-20260316","first-page":"CD005528","article-title":"Non-clinical interventions for reducing unnecessary caesarean section","author":"Chen","year":"2018","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"3","key":"R9-20260316","doi-asserted-by":"crossref","first-page":"e2021056035","DOI":"10.1542\/peds.2021-056035","article-title":"Telehealth: Opportunities to improve access, quality, and cost in pediatric care","volume":"149","author":"Curfman","year":"2022","journal-title":"Pediatrics"},{"issue":"5","key":"R10-20260316","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.jse.2018.10.007","article-title":"Inferior outcomes and higher complication rates after shoulder arthroplasty in workers\u2019 compensation patients","volume":"28","author":"Cvetanovich","year":"2019","journal-title":"Journal of Shoulder and Elbow Surgery"},{"issue":"12","key":"R11-20260316","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1016\/j.injury.2020.11.001","article-title":"Virtual fracture clinics in orthopaedic surgery\u2014A systematic review of current evidence","volume":"51","author":"Davey","year":"2020","journal-title":"Injury"},{"issue":"3","key":"R12-20260316","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1002\/ajim.20774","article-title":"Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999\u20132004","volume":"53","author":"Dunning","year":"2010","journal-title":"American Journal of Industrial Medicine"},{"issue":"Suppl 5","key":"R13-20260316","doi-asserted-by":"crossref","first-page":"S353","DOI":"10.4103\/2152-7806.120774","article-title":"Are recommended spine operations either unnecessary or too complex? Evidence from second opinions","volume":"4","author":"Epstein","year":"2013","journal-title":"Surgical Neurology International"},{"issue":"5","key":"R14-20260316","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1089\/tmj.2021.0221","article-title":"Telemedicine in orthopedic surgery: A systematic review of current evidence","volume":"28","author":"Fahey","year":"2022","journal-title":"Telemedicine Journal and E-Health"},{"issue":"7","key":"R15-20260316","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1016\/j.arth.2017.02.040","article-title":"High rate of local recurrence and complications following total knee arthroplasty in the setting of synovial chondromatosis","volume":"32","author":"Houdek","year":"2017","journal-title":"The Journal of Arthroplasty"},{"issue":"4","key":"R17-20260316","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.arth.2019.10.038","article-title":"Comparison of postoperative complications and survivorship of total hip and knee arthroplasty in dialysis and renal transplantation patients","volume":"35","author":"Inoue","year":"2020","journal-title":"The Journal of Arthroplasty"},{"issue":"3","key":"R18-20260316","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1093\/jamia\/ocaa310","article-title":"Telemedicine, privacy, and information security in the age of COVID-19","volume":"28","author":"Jalali","year":"2021","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"14","key":"R19-20260316","doi-asserted-by":"crossref","first-page":"624","DOI":"10.5435\/JAAOS-D-20-00620","article-title":"Cognitive biases in orthopaedic surgery","volume":"29","author":"Janssen","year":"2021","journal-title":"Journal of the American Academy of Orthopaedic Surgeons"},{"key":"R20-20260316","doi-asserted-by":"crossref","first-page":"14350","DOI":"10.1038\/s41598-022-18417-z","article-title":"Analysis of risk factors for perioperative complications in spine surgery","volume":"12","author":"Lange","year":"2022","journal-title":"Scientific Reports"},{"issue":"8","key":"R21-20260316","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/JOM.0000000000001630","article-title":"The relationship of the amount of physical therapy to time lost from work and costs in the workers\u2019 compensation system","volume":"61","author":"Leung","year":"2019","journal-title":"Journal of Occupational and Environmental Medicine"},{"issue":"5","key":"R22-20260316","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.jaad.2020.12.022","article-title":"Impact of second-opinion dermatopathology reviews on surgical management of malignant neoplasms","volume":"84","author":"Lohman","year":"2021","journal-title":"Journal of the American Academy of Dermatology"},{"key":"R23-20260316","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.urology.2016.01.048","article-title":"Change in management based on pathologic second opinion among bladder cancer patients presenting to a comprehensive cancer center: Implications for clinical practice","volume":"93","author":"Luchey","year":"2016","journal-title":"Urology"},{"issue":"10","key":"R24-20260316","doi-asserted-by":"crossref","first-page":"1138.e25\u20131138.e33","DOI":"10.1016\/j.amjmed.2015.04.020","article-title":"Evaluation of outcomes from a national patient-initiated second-opinion program","volume":"128","author":"Meyer","year":"2015","journal-title":"The American Journal of Medicine"},{"issue":"5","key":"R25-20260316","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.mayocp.2014.02.015","article-title":"Patient-initiated second opinions: Systematic review of characteristics and impact on diagnosis, treatment, and satisfaction","volume":"89","author":"Payne","year":"2014","journal-title":"Mayo Clinic Proceedings"},{"issue":"5","key":"R26-20260316","doi-asserted-by":"crossref","first-page":"e345","DOI":"10.1097\/JOM.0000000000002528","article-title":"Relationship analysis of injured workers\u2019 average weekly wages and workers\u2019 compensation indemnity claims in Maine, US: 1998 to 2017","volume":"64","author":"Pieretti","year":"2022","journal-title":"Journal of Occupational and Environmental Medicine"},{"issue":"11","key":"R27-20260316","doi-asserted-by":"crossref","first-page":"6165","DOI":"10.3390\/ijerph18116165","article-title":"Does workers\u2019 compensation status affect outcomes after lumbar spine surgery? A systematic review and meta-analysis","volume":"18","author":"Russo","year":"2021","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"12","key":"R28-20260316","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1377\/hlthaff.2018.05132","article-title":"The current state of telehealth evidence: A rapid review","volume":"37","author":"Shigekawa","year":"2018","journal-title":"Health Affairs"},{"issue":"22","key":"R29-20260316","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.5435\/JAAOS-D-22-00406","article-title":"Hip and knee arthroplasty outcomes for nonagenarian patients","volume":"30","author":"Sizer","year":"2022","journal-title":"Journal of the American Academy of Orthopaedic Surgeons"},{"issue":"4","key":"R30-20260316","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.pop.2022.05.004","article-title":"Asynchronous telehealth","volume":"49","author":"Stephens","year":"2022","journal-title":"Primary Care: Clinics in Office Practice"},{"issue":"12","key":"R31-20260316","first-page":"e57","article-title":"Telemedicine in the era of COVID-19: The virtual orthopaedic examination","volume":"102","author":"Tanaka","year":"2020","journal-title":"The Journal of Bone"},{"key":"R32-20260316","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1186\/s12891-021-04465-5","article-title":"Effects of a medical second opinion programme on patients\u2019 decision for or against knee arthroplasty and their satisfaction with the programme","volume":"22","author":"Weigl","year":"2021","journal-title":"BMC Musculoskeletal Disorders"},{"issue":"7","key":"R33-20260316","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.jacr.2019.01.006","article-title":"Specialized second opinion review of breast MRI impacts management and increases cancer detection","volume":"16","author":"Weinfurtner","year":"2019","journal-title":"Journal of the American College of Radiology"}],"container-title":["Journal of Healthcare Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/JHM-D-24-00256","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T21:00:19Z","timestamp":1773694819000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/JHM-D-24-00256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/jhm-d-24-00256","relation":{},"ISSN":["1096-9012","1944-7396"],"issn-type":[{"value":"1096-9012","type":"print"},{"value":"1944-7396","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]}}}