Midwest Orthopaedics at Rush shifts to telemedicine, postpones non-urgent surgery — key insights from Dr. Brian Cole

Practice Management

On March 19, Chicago-based Midwest Orthopaedics at Rush implemented new policies around patient visits and performing surgeries through mid-April due to the coronavirus outbreak. The time-line is subject to change based upon the nature of the demands on the local healthcare system.

The practice's surgeons are now seeing patients via telemedicine from their homes and shifting to in-person visits at the clinic only when absolutely necessary.

Midwest Orthopaedics at Rush has trained its nearly 100 providers on telehealth with all patients being triaged through telehealth and video consultation. The group sent out educational webinars and power points to its providers within 24 hours of beginning the new policies so all providers were updated on the technology and proper billing and coding information. The transition to telehealth visits is new, but not necessarily unwelcome among the surgeons.

"I've always wanted to use telemedicine more," said Brian Cole, MD, the managing partner at Midwest Orthopaedics at Rush and associate chairman of the department of orthopedics and chairman of the department of surgery at Rush Oak Park (Ill.) Hospital. He also serves as section head of the Cartilage Restoration Center at Rush. "If patients appreciate it and the reception is high, I anticipate we'll continue using it. Driving to the physician's office, waiting for any amount of time and then driving back to their work place or home is an onerous and inefficient process. It can be difficult for patients, especially those with limited resources, and video visits are more convenient. In some ways, we should have been doing this a long time ago."

Surgeons are also postponing elective surgeries that can be rescheduled, performing only urgent surgical procedures. The policies will be in effect until at least April 15. If neglecting care for four to six weeks will worsen the problem, the surgery is considered “urgent” and will move forward assuming the environment allows this to occur.

"This could change in the future if there comes a point where we can't even do orthopedic cases," said Dr. Cole. "At present time, the environment is permissive of urgent orthopedic cases if the patients' outcomes or function would be impacted if they don't receive treatment sooner than later, but that could change based on prioritization."

The long-term impact of the coronavirus on healthcare delivery and private practice is uncertain, and Dr. Cole sees the pandemic pushing for additional consolidation in the healthcare field. It could also force people to view their healthcare and priorities differently.

"People will always need orthopedic services, but I believe things will look differently," he said. "The common denominator is that this isn't about who does or doesn't have the coronavirus. Anyone is a potential carrier and thus the hospital systems are at significant risk of being overwhelmed. We have to be part of the solution. Business is important, but the economics are less important than the cost of mitigation and containment while treating sick patients."

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