Eight spine surgeons discuss how the pandemic will affect spine in ASCs, addressing patient selection, payer issues and the potential for acceleration in the future.
Richard Wohns, MD. Founder and President of NeoSpine and Microsurgical Spine Center (Puyallup, Wash.): We are in uncharted territory and it is at least clear that we will not return to the 'old normal.' The 'new normal' will likely include a greater interest by all stakeholders in outpatient spine surgery centers, promotion of telehealth options for patient care, and a new awareness of the 'costs' of doing business. The 'costs' include risks to health care providers, the underlying economics of healthcare in hospitals, clinics and ASCs, plus the role of medical insurance.
A silver lining may be less numbers of frivolous lawsuits that plague the house of medicine, as patients will hopefully realize how many healthcare providers risked or lost their lives taking care of patients with COVID-19. This pandemic has been a severe shock to the entire healthcare delivery system and severe shocks historically lead to severe repercussions. At the end of the day, I am optimistic that we will have learned painful lessons that will help us provide better care to our patients.
Andrew Hecht, MD. Chief of Spine Surgery at Mount Sinai Hospital and Mount Sinai Health System (New York City): The new normal looks will be less outpatient and surgical volume until there is a vaccine, truly effective drug, or herd immunity. Surgeons and patients must now weigh additional risks related to COVID-19 when seeing a patient or scheduling a surgery.
Kern Singh, MD. Co-Director of the Minimally Invasive Spine Institute at Rush (Chicago): The new normal is a dramatically reduced volume of clinic and surgical patients. My practice was already shifted towards the ASC environment and now with hospitals still being shut down it has only hastened that transition. More outpatient surgeries as patients are reluctant to spend time in hospitals with others who are infected with the COVID-19 virus.
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): As we open our doors to in-person visits versus telemedicine and begin performing elective surgeries, we may continue to have lower volumes due to patients' fear of hospitals as a place with higher concentration of COVID 19 patients. Furthermore, with a high level of unemployment and decrease in number of individuals with employer sponsored health insurance, we will see a decrease number of high cost elective surgeries unaffordable by individual patients. This will perhaps promote less invasive and lower costs surgeries that can be performed in surgicenters or as an outpatient in hospitals.
We will have to continue isolating our COVID-19 patients and staff caring for them in designated locations within our facilities to minimize the risk of nosocomial infections. We need to gain the trust of our communities by showing them that hospitals and surgical facilities remain safe havens for healthy patients' elective surgical needs.
Mick Perez-Cruet, MD. Beaumont Hospital (Royal Oak, Mich.): Normal might take some time to achieve, at least till an effective treatment or vaccine is out. Until then precautions will be in place and we will just have to do the best we can. I do see more of a shift to doing cases at the ambulatory surgery center. Ultimately this might favor reduced spine care cost.
Choll Kim, MD, PhD. Spine Institute of San Diego: More and more spine surgeries will be performed in the ASC setting. This is the natural evolution of all surgical specialties. The question is, and has been, when? The COVID-19 crisis, while devastating, may give us the needed 'activation energy' to pursue this important effort, which in turn will stimulate advancements in MIS technologies, ERAS, cost efficiency, customer service, complication management, and most importantly greater surgeon engagement in facility operations. I see a perfect storm brewing. The COVID-9 crisis has brought it much closer to land.
Michael Smith, MD. Rothman Orthopaedics (Philadelphia): A major opportunity we could take from the COVID-19 crisis is sharpening our drive to move the great majority of spine surgical care out of hospitals. A variety of cultural, institutional, financial and regulatory issues make it easy for many of us to keep operating in a hospital. It is comfortable for most of us; it is how most of us trained, and most of our learned professors had no reason to bother looking outside the hallowed halls.
But we see a great limitation in our hospitals now as they have been suddenly and completely taken from us by a single virus. Hospitals are not specifically built to be optimized for spinal care.
ASCs, especially with an overnight nursing option, and facilities that can extend care for one to two postoperative days should be able to accommodate a significant majority of spinal care. Minimally invasive techniques support this transition. Surgeon ownership and management of these centers can build efficiencies for the physicians and the patients that are structurally impossible in a large and complicated hospital. For those of us who have really only known life in academic medical centers, where the surgeon's control of anything other than the actual cutting is very limited, could find this a brave and bright new world.
Scott Boden, MD. Emory Orthopaedics & Spine Center (Atlanta): The early recovery phase of the COVID-19 pandemic may divert some additional spine cases from hospital outpatient departments to free-standing ASCs because of a perception that those outpatient facilities may be COVID-19-free. In reality, proper personal protective equipment, screening, patient cohorting and hand hygiene should enable all healthcare facilities to remain COVID-19-safe. ASCs and their staff and patients will not be immune from COVID-19 given the community spread and high prevalence of asymptomatic carriers.