Dr. Fred Naraghi: Future crises should consider the paradox of 'bending the curve vs. crashing the system'

Alan Condon -  

In February, Fred Naraghi, MD, moved his practice from San Francisco to Klamath Orthopedic Clinic in Klamath Falls, Ore., citing both financial and personal reasons. 

For independent physicians already struggling with rising costs and declining reimbursements, the pandemic struck at a particularly bad time. 

Dr. Naraghi spoke to Becker's Spine Review about how the COVID-19 pandemic affected his practice and how he expects it to change spine care.

Question: How has your practice been affected by the coronavirus pandemic? 

Dr. Fred Naraghi: As we are all navigating through the new environment of the COVID-19 pandemic, everything is changing daily. Although this was not entirely unprecedented, it was absolutely sudden and shocking. We have all had to hold off on our elective surgeries. We started using telehealth for visits, but it's been a mixed experience as telehealth is quite limited in orthopedic or neurologic exams. There are software and technology challenges as well.

Our hospital leadership has been very proactive as we started early on to take precautionary steps, that helped keep the virus numbers down, and it's been very successful. In our area, Klamath Falls, we've crushed the curve. Moving forward, however, we all need to consider the paradox of bending the curve versus crashing the system, as one of my colleagues described it. 

Q: How is your practice preparing for the ramp-up period of surgical cases? How many backlogged cases do you currently have?

FN: We are considering restarting elective cases cautiously, with a phased ramp-up plan, while carefully monitoring for a possible surge, keeping track of personal protective equipment and ensuring the safety of our patients and staff. 

I have about 30 cases backlogged and that puts a significant stress on our system, but we'll prioritize based on severity of the symptoms, availability of preop clearance, and timing with the limited phase 1 OR schedule availability. Our team is efficient and closely working with the hospital to coordinate the ramp-up and get elective cases scheduled. I think it is important to prepare for the ramp up as a team, as COVID-19 treatment options become available and we restart the engine.

Q: What cost-saving measures is your practice taking during the current crisis?

FN: We have started rotating the providers as well as the supporting medical assistants and staff. Also, we have started to use telehealth for visits, but with some mixed results. Orthopedic and neuro exams are quite difficult to elicit on a video chat and there are definite technology limits from the clinic as well as from the patient side.

Q: How will the coronavirus change spine care?

FN: These are unprecedented times, and everything is changing daily. The full economic impact still remains to be seen. I'm confident we will get through this, because we always have. Sooner or later, we will find a way to treat the coronavirus, or at least get it under control. My impression is that we would likely emerge into a different normal, and I don't think we can ever go back to the previous normal. 

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