Richard Chua, MD, a neurosurgeon with Northwest NeuroSpecialists in Tucson, Ariz., spoke to Becker's Spine Review about how his practice has been affected by the COVID-19 pandemic and steps he is taking to return to elective surgeries on May 1.
Note: Responses are lightly edited for style and clarity.
Q: How has your practice been affected by the coronavirus pandemic?
Dr. Richard Chua: The pandemic has created significant patient care, access and financial strain on the practice. Now going on week six of the governor's declaration to stay home and cancel elective surgeries, we have adapted as best we could to set up virtual visits and use telemedicine, but still see patients with urgent/emergent conditions, and have continued to perform emergency surgeries. We closed our office one day per week to reduce operating expenses and overhead. We canceled approximately 50 elective surgeries for our three surgeons.
Q: How is your practice preparing for the ramp-up period of surgical cases? How many backlogged cases do you currently have?
RC: We will be following our hospital, county and state health department, governor's office, CMS, and American College of Surgeon recommendations and plan on resuming very limited elective surgeries on May 1. These will be limited to outpatient and observation cases; patients must be discharged from the hospital by 9 p.m.; and all patients must be COVID-19 negative on antigen tests performed 48-72 hours prior to surgery. Other specifications include adequate hospital bed capacity [and] adequate personal protective equipment. If the hospital is unable to maintain the certification guidelines, then we will be shut down for a minimum of two weeks.
Q: What cost-saving measures is your practice taking during the current crisis?
RC: We have closed our office one day a week to reduce operating expenses and overhead, including staff pay. In addition, since clinic volume is reduced about 40 percent to 50 percent, we have rotated our office staff working in the clinic on the other days, and have furloughed nonessential staff.
Q: How will the coronavirus change spine care?
RC: It is amazing to see how many patients have accommodated to this time when the access to spine care was more difficult. Some patients have taken more accountability and responsibility for their own home care, and some have improved without additional care because they are not working or carrying on with their normal activity level. However, I remain concerned about how patients will be able to accommodate or proceed with spine surgical care after being off work for so long, yet may have to take time off if they have their spine surgery.
We may see many months of delays in patients proceeding with their surgery because of their need to go back to work to earn a living. We will likely have learned from this and hopefully will apply to the future. I strongly believe there will be a new role for telemedicine in spine care in the future, if the regulatory, insurance and reimbursement factors change for the better.