How 5 spine practices are proceeding with recovery plans — boosting telemedicine, opening a new center & more

Alan Condon -  

Five spine surgeons detail how their practices have been affected by the COVID-19 pandemic and what their recovery plans are for the future.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: As elective surgeries resume, what patients and surgeries are you prioritizing? Why?

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, June 3.

Note: The following responses were lightly edited for style and clarity.

Question: How has the COVID-19 pandemic affected your practice? What are your recovery plans over the coming months?

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The number of elective cases and patient visits was significantly reduced, as was the subsequent revenue. We had to reduce our office hours and our employees and staff were affected greatly. Also, patients whom we had been watching were at the end of their nonsurgical management "rope," so some of them converted to surgery. We worked hand in-hand with our hospital and surgery center partner to make sure all of our bases were covered. Fortunately, everyone did fine and no COVID-19 infections have been noted.  

One good thing that did come though was the initiation of our second opinion site, as well as developing a robust telemedicine practice. My staff quickly learned through the published guidelines from CMS and began billing as soon as we could. We partnered with a great, inexpensive company that offered an effective and simple solution to our telemedicine that allowed me to chart, share screens and engage, almost as if we were in person.  

Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): After nearly three decades of practice, the majority of my surgical caseload is complex spinal surgery, which almost from the outset, was curtailed due to national personal protective equipment concerns and hospitals preparing for what was projected as incalculable volumes of infirmed patients. These restrictions were honored by our health system and other nonprofit hospitals, where a number of for-profit institutions were sanctioned over "business as usual" practices of large gatherings and tepid precautionary stances.

Emergencies were cared for as per custom and urgencies were reviewed by a surgical committee for appropriateness of scheduling and timeliness of surgical rendering. These restrictions of recent have been lifted. The hospitals are gearing up for elective practices and making all possible attempts to accommodate the surgeon's needs. The plan for the future is to make do with what's available, work on coping skills that were never finely tuned and hopefully get back to some semblance of normality. 

Jeffrey Wang, MD. USC Spine Center (Los Angeles): All healthcare facilities have been impacted by the COVID-19 pandemic, both with patient care delivery and with financial concerns. While some physicians have retired due to the loss of revenue and the bleak outlook projections of limited revenue in the near future, our strategy is to adopt safety measures into a completely different patient flow to maintain safety of patients and staff while allowing business to slowly and methodically resume. The sooner we can adopt to the "new" normal, the better. I believe many practices are adopting similar [measures] to determine how to best resume seeing patients and performing surgeries with all the necessary precautions. 

Issada Thongtrangan, MD. Microspine (Phoenix): As an independent physician in private practice, I am facing a new reality and a new normal. I am doing everything in my power to lower overhead expenses without interfering with patient care or outcomes. We are triaging patients before they come inside. We give patients a face mask if they have to be seen face-to-face and we set up telehealth visits for high-risk patients. We sanitize our office very often throughout the day and adjust our waiting room area and the traffic. Patient and staff safety are our priorities, and we are dealing with the surgical backlogs. 

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The pandemic has affected almost all aspects of life and business in the U.S. over the past three months. I have been working on opening my solo practice right in the middle of it. Fortunately, we have been able to stay on task with only minimal delays and Sinkov Spine Center will open its doors to patients on June 1. The biggest challenges have been finding medical supplies, cleaning supplies and PPE. We have been fortunate to work with a great medical supply company and our rep has found a very inventive way to get us what we need, so we can have a properly supplied office and provide PPE for our staff.  All other aspects of opening the new office have also been slower than I would like, such as credentialing, finding contractors for remodeling, getting proper permits/licenses/inspections and working with various vendors. We were lucky to be in a position to be able to hire employees, while other businesses have been laying people off.  

We are prepared to grow over the coming months as the restrictions ease up. We have all the policies and procedures in place to keep patients and staff safe. Since the hospitals are now allowing elective surgeries to proceed, I expect my practice to ramp up quickly. 

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