Original Article

COVID-19 Impact on Orthopedic Surgeons: Elective Procedures, Telehealth, and Income

Authors: Kyle D. Paul, BS, Eli Levitt MS, Gerald McGwin, PhD, Eugene W. Brabston, MD, Shawn R. Gilbert, MD, Brent A. Ponce, MD, Amit M. Momaya, MD

Abstract

Objectives: The purpose of this study was to investigate the response in orthopedic surgery to the coronavirus disease 2019 (COVID-19) pandemic across the United States by surveying surgeons about their care setting, timing of restrictions on elective surgery, use of telehealth, and estimated economic impact.

Methods: A survey was distributed via REDCap through state orthopedic organizations between April and July 2020. The 22-question digital survey collected information regarding restrictions on elective procedures, location of care, utilization of telehealth, and estimated reductions in annual income.

Results: In this study, 192 participants responded to the survey (average age 49.9 ± 11.0 years, 92.7% male). Responses primarily originated from Alabama (30.2%), Georgia (30.2%), and Missouri (16.1%). The remainder of the responses were grouped into the category “other.” Respondents did not vary significantly by state in operative setting or income type (salary, work relative value units, or collections). Most of the participants documented elective procedure restrictions in hospital and ambulatory settings. The highest frequency of closures occurred between March 18 and 20 (47% in hospital, 51% in ambulatory). Of the participants, financial loss estimates varied across states (P = 0.005), with 50% of physicians claiming >50% losses of income in Alabama (24% Georgia, 10% Missouri, 31% other). Regarding telehealth, practices set up for these services before 2020 varied across states. None of the orthopedic practices in Alabama had telehealth before the COVID-19 pandemic (Missouri 25%, Georgia 9%, other 8%, P = 0.06); however, respondents generally were split when considering the anticipation of implementing telehealth into routine practice.

Conclusions: Most practices did implement restrictions for elective clinic visits and procedures early during the pandemic. COVID-19 ultimately will result in a large revenue loss for elective orthopedic practices. Services such as telehealth may help offset these losses and help deliver orthopedic care to patients remotely.
Posted in: Infectious Disease65 Rheumatology and Orthopedics14

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Table 1. Characteristics of and practice information on respondents to the survey, N = 192

Download Image

Table 2. Hospital restrictions, telemedicine and economic estimates, grouped by state

Download Image

Fig. What reduction in annual income do you anticipate secondary to COVID-19? COVID-19, coronavirus disease 2019.

Download Image

References

1. World Health Organization. Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Published 2020. Accessed February 9, 2020.
 
2. Bartik AW, Bertrand M, Cullen Z, et al. The impact of COVID-19 on small business outcomes and expectations. Proc Natl Acad Sci USA 2020;117:17656–17666.
 
3. Li YM, Galimberti F, Abrouk M, et al. US dermatology resident responses about the COVID-19 pandemic: results from a nationwide survey. South Med J 2020;113:462–465.
 
4. Gisondi P, Piaserico S, Conti A, et al. Dermatologists and SARS-CoV-2: the impact of the pandemic on daily practice. J Eur Acad Dermatol Venereol 2020;34:1196–1201.
 
5. Louie PK, Harada GK, McCarthy MH, et al. The impact of COVID-19 pandemic on spine surgeons worldwide. Global Spine J 2020;10:534–552.
 
6. Maffia F, Fontanari M, Vellone V, et al. Impact of COVID-19 on maxillofacial surgery practice: a worldwide survey. Int J Oral Maxillofac Surg 2020;49:827–835.
 
7. Vaccaro AR, Getz CL, Cohen BE, et al. Practice management during the COVID-19 pandemic. J Am Acad Orthop Surg 2020;28:464–470.
 
8. Adams J., Office of the US Surgeon General. https://twitter.com/surgeon_general/status/1238798972501852160. Published March 14, 2020. Accessed September 2, 2020.
 
9. Centers for Medicare & Medicaid Services. CMS adult elective surgery and procedures recommendations. https://www.cms.gov/files/document/covidelective-surgery-recommendations.pdf. Published April 7, 2020. Accessed March 12, 2021.
 
10. American Academy of Orthopaedic Surgeons. COVID-19 guidance for elective surgery. https://www.aaos.org/about/covid-19-information-for-ourmembers/aaos-guidelines-for-elective-surgery. Accessed September 2, 2020.
 
11. Alola AA, Alola UV, Sarkodie SA. The nCOVID-19 and financial stress in the USA: health is wealth. Environ Dev Sustain 2020;October 8:1–12.
 
12. Ibn-Mohammed T, Mustapha KB, Godsell J, et al. A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies. Resour Conserv Recycl 2021;164:105169.
 
13. American Medical Association. CPT Professional 2020 Edition. Chicago, IL: American Medical Association; 2020.
 
14. Office for Civil Rights at the US Department of Health & Human Services. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. https://www.hhs. gov/hipaa/for-professionals/special-topics/emergency-preparedness/ notification-enforcement-discretion-telehealth/index.html. Published 2020. Accessed February 9, 2020.
 
15. Delaplain CB, Lindborg CE, Norton SA, et al. Tripler pioneers telemedicine across the Pacific. Hawaii Med J 1993;52:338–339.
 
16. Cohen JK. The growth of telehealth: 20 things to know. https://www.beckershospitalreview.com/healthcare-information-technology/thegrowth-of-telehealth-20-things-to-know.html. Published 2017. Accessed February 9, 2020.
 
17. Tanaka MJ, Oh LS, Martin SD, et al. Telemedicine in the era of COVID-19. J Bone Jt Surg 2020;102:e57.
 
18. US Postal Service. State abbreviations. https://about.usps.com/who-we-are/ postal-history/state-abbreviations.pdf. Accessed March 12, 2021.
 
19. Pasquini-Descomps H, Brender N, Maradan D. Value for money in H1N1 influenza: a systematic review of the cost-effectiveness of pandemic interventions. Value Health 2017;20:819–827.
 
20. Anoushiravani AA, O’Connor CM, DiCaprio MR, et al. Economic Impacts of the COVID-19 Crisis. J Bone Jt Surg 2020;102:937–941.
 
21. Navarro RA, Reddy NC, Weiss JM, et al. Orthopaedic systems response to and return from the COVID-19 pandemic: lessons for future crisis management. J Bone Jt Surg Am 2020;102:e75.
 
22. Cherf J. A snapshot of U.S. orthopaedic surgeons: results from the 2018 OPUS survey. AAOS Now. https://www.aaos.org/aaosnow/2019/sep/youraa os/youraaos01. Published September 1, 2019. Accessed September 2, 2020. .
 
23. Ambulatory Surgery Center Association. State guidance on elective surgeries. https://www.ascassociation.org/asca/resourcecenter/la testnewsresourcecenter/covid-19/covid-19-state. Updated April 20, 2020. Accessed September 2, 2020.
 
24. Mi B, Xiong Y, Lin Z, et al. COVID-19 orthopaedic safe care toolset: guidelines for the diagnosis and management of patients with fracture and COVID-19. J Bone Jt Surg 2020;102:1116–1122.
 
25. American Academy of Ophthalmology. States limiting elective procedures in hospitals, resuming surgery in all settings. https://www.aao.org/practice-ma nagement/article/states-begin-easing-elective-procedure-restriction. Published July 16, 2020. Accessed August 30, 2020.
 
26. Parisien RL, Shin M, Constant M, et al. Telehealth utilization in response to the novel coronavirus (COVID-19) pandemic in orthopaedic surgery. J Am Acad Orthop Surg 2020;28:e487–e492.
 
27. Lanham NS, Bockelman KJ, McCriskin BJ. Telemedicine and orthopaedic surgery: the COVID-19 pandemic and our new normal. JBJS Rev 2020;8:e2000083.