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A Second Opinion Could Help Curb Wasteful Healthcare Spending in the US

On today’s episode of the MarketScale Healthcare podcast, Voice of B2B Daniel Litwin explores waste in the American healthcare system. A recent October 2019 study in JAMA by Dr. William Shrank showed waste makes up almost a quarter, or 25%, of U.S. healthcare spending, which, when quantified, can reach $935 billion by some estimates….

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A Second Opinion Could Help Curb Wasteful Healthcare Spending in the US

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On today’s episode of the MarketScale Healthcare podcast, Voice of B2B Daniel Litwin explores waste in the American healthcare system.

A recent October 2019 study in JAMA by Dr. William Shrank showed waste makes up almost a quarter, or 25%, of U.S. healthcare spending, which, when quantified, can reach $935 billion by some estimates.

How does this impact the system as a whole? What are some potential solutions? We’re spoke to both of those major questions today with Jason Melton, CEO of 2nd.MD, who’s looking to combat waste in our healthcare system through medtech.

Specializing in medical certainty, 2nd.MD connects patients to a network of hundreds of expert physicians ready to give a second opinion on their diagnosis and treatment plan, with the goal being to create an optimum treatment plan from the beginning to significantly improve outcomes and reduce ineffective or unnecessary medical spend.

Melton and Litwin spend the podcast breaking down…

  • How 30% of healthcare costs are wasted on unnecessary or incorrect care
  • How wasteful spending fits into the broader dynamic of overspending in American healthcare
  • The financial and health effects of incorrect care on physicians and patients
  • Where a medtech solution fits into the mission to curb wasteful care spending
  • How 2nd.MD created and expanded their network of physicians

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Denials get a queue, underpayments just look like paid claims

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Underpayments in healthcare revenue cycle operations lack the visibility of denied claims because they don't trigger alerts or queue workflows. Without dedicated ownership and line-level verification against contract terms, paid claims that fall short of their contractual amount pass through undetected.

  • 01Denial workflows activate on rejection events, but underpayments produce no event, leaving paid claims unverified by default.
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  • 01When a contract packages add-ons into the primary procedure, the add-on line may legitimately show zero payment because it is folded into the primary procedure reimbursement.
  • 02Pursuing payment differences that lack contract support burns credibility with payers and can weaken the team’s position on later disputes, including valid ones.
  • 03Always verify the complete contract terms, fee schedules, carve-outs, amendments, and the specific version in effect on the date of service before treating a payment variance as a recoverable underpayment.

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A clean, paid, closed claim can still be short of the contract

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  • 01Correctly coded and billed healthcare claims can still result in underpayment.
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