Transformational change: 4 predictions on how COVID-19 will affect spine and healthcare

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Across the nation, non-essential businesses have closed or transitioned to remote work while hospitals and surgical centers have canceled elective procedures to avoid further spreading the coronavirus and devote resources to treating COVID-19 patients.

The federal government is delivering billions to healthcare organizations to support those efforts, and the $2 trillion stimulus package has special provisions for small businesses, including ASCs. Congress is considering a second stimulus package that would include a big focus on funding healthcare organizations. The pandemic is transforming healthcare on every level and the agile organizations that keep quality care and patient experience top of mind will thrive.

"Over the past 20 years, three crises have caused fundamental industry transformation. The terrorist attacks of 9/11 brought about a complete change in domestic security and the homeland security industry; the 2008 financial crisis brought about fundamental changes to the banking and financial industry; and the current COVID-19 pandemic will drive transformational change in healthcare," said Alok Sharan, MD, Director of Spine and Orthopedics at NJ Spine and Wellness. "With every transformation, society and government has identified a problem and developed a solution, and that is the roadmap for the future. If you drill down to really understand the problem, you will be able to predict how the healthcare industry will be transformed."

Here, Dr. Sharan outlines four big ways healthcare will change as a result of COVID-19.

1. There will be more centralized command and governance of healthcare to make efficient resource allocation. COVID-19 has highlighted several big issues with the U.S. healthcare system, including resource allocation, information sharing, and lack of collaboration. Now, competing organizations and health systems are collaborating to ensure healthcare providers have what they need to care for patients. In the hardest hit areas, including New York, the state government has taken over a lot of control of healthcare to force more sharing of resources among hospitals and providers. .

"States and governments will most likely create an organization similar to the Homeland Security Department that has the authority to acquire the necessary information and power to make sure they understand what the problem is, such as identifying where more supplies are needed, and making a decision," said Dr. Sharan. "In the future this will be an issue of national security. If governments don't have that power, the next time this happens we won't be able to react any better."

Dr. Sharan envisions a new type of governing body that will manage the data aggregation and reporting in healthcare. CMS has already directed hospitals to send daily updates on COVID-19 testing as well as bed capacity and supply needs so the federal government can respond accordingly.

2. Healthcare organizations will engage in greater information sharing. Long before the coronavirus emerged, the ONC began examining its guidelines around interoperability with the 21st Century CURES Act. In early March, the agency announced new guidance that prohibits blocking the spread of information blocking and gives patients access to their personal health records. As the coronavirus hit, the federal government continued to relax regulations around information sharing to ensure the best outcomes possible during the pandemic.

"There is no question now that there will be greater sharing of medical records between hospitals and providers," said Dr. Sharan. "Patients need to be able to take their information from one place to the next via a personal health record, much like they can take their debit cards from one bank to the next and withdraw funds without extra cost. In healthcare, going from one system to another should be seamless for the patient."

In the future, as healthcare organizations share more information, it will be easier to coordinate care and devote resources to areas that need them most. "If we hadn't had an issue with information sharing, we could have very quickly been able to pass patients from one hospital to another or deliver PPE where it was needed," Dr. Sharan said.

3. Patients will take a more active role in their care. Many orthopedic and spine surgeons have turned to telemedicine during the pandemic to stay connected with their patients. With the expanded access to telemedicine, and as the patient comfort level increases, it will be easier for patients to shop for their care. Coupled with the ability to take their health records with them, patients won't need to be locked into one provider or health care system.

"For spine surgery in particular, I believe that patients will look online for the best surgeon for their care," said Dr. Sharan. "If you look at Google right now, one of the most searched words is 'sciatica.' Even during the pandemic, people are still going online and looking for treatments for their back pain, and in some ways the pandemic made that worse. Patients are going to shop around and find the providers they can quickly connect with via telemedicine and coordinate care."

Patients will also be attracted to orthopedic and spine practices that offer a "center of excellence" approach to coordinated care, providing surgical, non-surgical, chiropractic care and physical therapy. "The market will push providers to coalesce around that idea because patients will want that type of care," said Dr. Sharan. "When the time comes for surgery, patients will also look for a surgeon who can perform outpatient cases in the ASC."

4. More patients will want surgery in an ASC. Now more than ever, patients are trying to stay out of hospitals. There will be tremendous national attention on how viruses and disease can spread in the hospital setting, even with the most sophisticated infection control practices in place. As a result, people will want to have their procedures in an ASC whenever possible and return home for recovery.

"I think ASCs will open for elective procedures sooner than hospitals that had to convert their operating rooms into ICUs and are taking care of COVID-19 patients. ASCs will have an easier time ramping up," said Dr. Sharan. "The initial elective volume will be picked up by ASCs, and if they can prove that they deliver safe, effective surgical care, patients will tell their friends about the great experience. Surgeons should position themselves to be affiliated with an ASC if they can."

Dr. Sharan developed the awake spinal fusion procedure as a means to safely perform outpatient lumbar fusions in the outpatient setting. As care migrates more towards the ambulatory setting he sees this as becoming a more realistic option for patients in the future. "I'm confident in the ability of awake spine surgery to deliver high-value more efficient care," he said.


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