Eleven spine surgeons outline the most exciting opportunities in the field over the next several months as their practices change due to the pandemic.
Charles Branch Jr., MD. Executive Director of the Spine Service Line at Wake Forest Baptist Health System (Winston-Salem, N.C.): I believe the most intriguing opportunity involves the seamless integration of imaging and video telehealth visits. While there has been a rapid increase in access to video telehealth, the availability of imaging from outside institutions that are not in the network is still problematic. I believe this opens an opportunity for an entrepreneurial solution to allow for outside imaging to link up with video telehealth. This environment also encourages the widespread use of wearable or other home patient monitoring technology that gives us better or more evidence-based patient outcomes and will ultimately add significantly to our decision-making capacity.
Richard Wohns, MD. Founder and President of NeoSpine and Microsurgical Spine Center (Puyallup, Wash.): We immediately realized the benefits of telehealth and plan to incorporate this into our practice after the lockdown is phased out. Despite the overwhelming downside related to the coronavirus pandemic and quarantine, the benefit of outpatient spine surgery in this setting was highlighted. It proved to be a safe conduit for patients in need of urgent or emergency spine surgery, when hospital access was severely limited or risky, or when patients' fear led to refusal of admission to a hospital.
For example, in an somewhat analogous situation where there have been a marked diminution in the number of strokes and myocardial infarctions seen in hospital emergency departments attributable to patients' fear of going to a hospital, yet now an increased number of patients being admitted with more advanced brain and heart damage due to lack of early treatment. We are not seeing a similar scenario related to spine pathology. This is due to lack of fear, or at least less fear, of patients going to an outpatient center for urgent or emergency spine surgery in the case of severe radiculopathy, myelopathy or spine related pain.
Andrew Hecht, MD. Chief of Spine Surgery at Mount Sinai Hospital and Mount Sinai Health System (New York City): One of the positive things that has come from this is the use of telemedicine to see patients. This has enabled us to see patients all over New York.
I also have felt the extreme collegiality and friendship of spine surgeons across hospitals in our area and nationally during this difficult time. In a time of great competition among healthcare systems, I think this pandemic refocused our attention on the fact that we are all in this together.
Choll Kim, MD, PhD. Spine Institute of San Diego: The most exciting opportunity is to expand the geographic area of my professional life. I can now evaluate patients from all over the world. In addition, I can readily connect with my colleagues through web conferencing and webinars. For someone who does not like air travel, remote conferencing will increase these opportunities for me.
Scott Boden, MD. Chair of the Department of Orthopaedics at Emory University School of Medicine and Vice President for Business Innovation at Emory Healthcare (Atlanta): The most exciting opportunities for us moving forward center around using telemedicine and increased pre-visit digital information gathering to make the actual visits more efficient for patients and physicians alike.
Kern Singh, MD. Co-Director of the Minimally Invasive Spine Institute at Rush (Chicago): I hesitantly say telemedicine. This technology has an opportunity to allow my practice to more easily engage patients across the United States. In this sense, the technology is game changing. I am still struggling with the inefficiencies of the interaction, especially the inability to truly review diagnostic imaging.
Mick Perez-Cruet, MD. Beaumont Hospital (Royal Oak, Mich.): Opportunities in regenerative medicine and advances in minimally invasive spine surgery. We are also excited about showing our outcomes in MIS surgery via the Michigan Spine Surgery Improvement Collaborative. A Michigan Blue Cross and Blue Shield sponsored initiative that has enrolled over 50,000 spine surgery patients so far.
Dwight Tyndall, MD. Dr. Spine (Munster, Ind.): The most exciting opportunities is the acceleration of the trend to outpatient spine surgeries and the use of telemedicine to deliver care.
Charley Gordon, MD. Precision Spine Care (Tyler, Texas): Probably the most exciting opportunity moving forward for us has been the dramatic acceleration of telehealth. It's my hope that the regulatory agencies allow us to continue the current climate of telehealth medicine. This is certainly more convenient for patients and, especially for established visits is more efficient.
Nick Shamie, MD. Chief of Orthopedic Spine Surgery and Vice Chairman of International Affairs at the David Geffen School of Medicine at UCLA (Los Angeles): I believe the healthcare field has gained a renewed and positive attention from our society; people recognize how 'essential' and committed healthcare workers are to our communities. We have seen decades of scrutiny and bad press chipping away at the 'doctor-patient' relationship. I believe we can use this opportunity to foster even more trusting relationship in our mission of 'healing humankind.....one patient at a time.'
Paul Slosar, MD. President of SpineCare Medical Group (Daly City, Calif.): The word 'exciting' is not on my radar currently, but hopefully soon. I will be 'excited' to see our patients' fear levels reduced and for my partners and I to return to providing care on a more predictable and consistent basis. As the administrative partner in our practice, my key practice administrators and I have had to devote an enormous amount of energy toward all the financial support programs and loan application work, in order to try and bridge the gap in revenue which we anticipate will be most painful in the next two to three months.
Our collective goal, as a practice, is to emerge lean and resilient. I have been remarkably surprised by the rapid pace of adoption using telemedicine, but in spine or orthopedics we must still perform a physical exam, so I don’t see that being a complete revolution in our care delivery. It will be great for routine follow up care and I believe we will see much more of that moving forward.
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