Ninety-seven percent of medical practices have suffered a financial hit due to the cessation of elective surgeries in the wake of the COVID-19 pandemic, and the orthopedic specialty is no different.
A whirlwind few weeks since the pandemic has seen monthly practice revenues drop substantially, ubiquitous industry furloughs and orthopedic surgery leaders working to develop a strategic pathway back to a safe environment for elective surgeries.
One positive that has arisen out of the healthcare crisis is CMS' expansion of telemedicine. But how will payers view the technology post-coronavirus?
Andrew Shadid, CEO of St. Charles, Ill.-based Genesis Orthopedics & Sports Medicine, spoke to Becker's Spine Review about how his practice has been preparing for elective surgeries to recommence and proving the value of telemedicine to payers.
Question: How much of a financial impact has the COVID-19 pandemic had on your practice? How hard have monthly revenues been hit?
Andrew Shadid: The numbers that we're expecting for elective specialties, including orthopedics are between 60 percent to 85 percent revenue declines. This is somewhat dependent on subspecialty and geography. As for planning, one wants to be a little more aggressive, assuming the worst case scenario.
Q: Have you applied for any government financial assistance?
AS: We're pushing for the Small Business Association 7a and 7b programs, an Economic Injury Disaster Loan Program grant and many of the other state and local grants. The HSS grant to those groups seeing Medicare also came through. Every little piece of revenue is helpful right now to ensure stability.
Q: How are you preparing for the ramp-up period when elective surgeries resume?
AS: We're rearranging our provider schedules to prepare for a surge, although I'm not sure it's going to be the surge that everyone is expecting. We're likely talking about a slow ramp-up, so we want to be able to increase our peak capacity as we begin climbing that mountain. The goal now is to continue to defer resources into the future when we begin hitting practice capacity again. Surgery, on the other hand, might be a little different. Every orthopedic practice now has a backlog of elective cases, which they will hope to get in as soon as possible, so that will be a bit different than the office setting.
Q: How many orthopedic surgeries are you projecting to be backlogged?
AS: We've canceled more than a month of elective cases, so we're looking at at least 10 to 15 percent of our annual case count that is now being deferred into the future. Interestingly, ensuring patients feel safe having these surgeries again may be a bigger challenge than we initially expected. It would not be correct to assume 100 percent of these patients will reschedule immediately after elective surgeries are possible.
Q: What do you see as the biggest challenge once elective surgeries recommence?
AS: We'll be fighting for OR time. We're going to be working with our surgery centers and hospitals to make sure the cases we have can get in at a timely manner. We're going to be competing for OR time with many other specialties and physicians. I think it will be important to bring cases to the table and become more efficient as a healthcare system, because we're going to have to do a lot more with less for the next several months.
Q: On a more personal note, how has your day-to-day changed since the pandemic?
AS: My work has been significantly different. COVID-19 changes required all hands on deck. It first became crisis management. We had to ensure staff felt safe, and patients also felt safe. We then launched telemedicine within 12 hours of confirming a stay-at-home order in Illinois. This evolved into new workflows and processes. Patients still needed to come into the office, appointments needed to be booked, patients needed casts, X-rays, MRIs and the like, yet at a different cadence than before. We then shifted to short term resource planning. While this feels somewhat structured in hindsight, the reality is that we have been making daily decisions as we gain more knowledge and insight.
All of our staff have taken on some level of a change of their job description, which has pushed us as an organization, but we are also seeing employees step up and shine under pressure, no different than an athlete in a championship game. Overall, we must prepare for a similar shift back to a more regular routine, which is requiring just as much energy as the shift to accommodate COVID-19.
Q: Has telemedicine offered some financial respite since CMS expanded its indications in March?
AS: Telemedicine is never going to make up the totality of what we need to maintain revenue. In orthopedics, we perform diagnostics, procedures and surgeries. If you take the average orthopedic surgeon who is in surgery two days a week, we immediately lose roughly 40 percent of revenue producing days. On top of that, there is a reduction of injections and X-rays and MRIs. Furthermore, there is a reduction in injuries as a result of cessation of sports and other activities.
Only a portion of activity can be made up via telemedicine, which amount to video visits billed at E&M rates. Thankfully payers in Illinois, due to a parity requirement by Gov. J.B. Pritzker, must pay for these services at the full rate. Unfortunately, that is not the case in all states.
Q: How do you see telemedicine developing post-COVID-19?
AS: This is the most interesting question to me. We know for a fact that it is not going to go away once President Trump or Mr. Pritzker lift stay-at-home orders. We know there are going to be certain subsets of the population that are deemed as high risk with continued recommendations for social distancing and reduced contact. Telemedicine will stick for a period of time.
The question is — how long?
Payers must respond to this new reality. Everyone must remember that telemedicine is not new. However, it has not taken off because major payers, including CMS have not widely paid for it. A 20-year struggle for telemedicine parity changed overnight when stay-at-home orders went into place, CMS authorized care when a patient was at home and governors required insurers to follow suit. While the keys are being held by the payers, the orthopedic community has a unique opportunity to guide insurers toward the locks and prove the value of telemedicine now. If we do this, telemedicine will be here to stay.