Three years after COVID-19 was deemed a global pandemic, some spine practices have made permanent the changes they had to implement. Here's how five spine surgeons are looking back at the early months of the pandemic.
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. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: It has been more than three years since the WHO declared COVID-19 a global pandemic. What is an adjustment in your practice that you will continue going forward?
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.):
A positive movement that I plan to incorporate into my practice going forward is performing most of my surgeries at ambulatory surgery centers. During and after COVID-19, patients were concerned about being in a busy and possibly understaffed hospital in the vicinity of COVID-positive patients. The movement towards doing more surgeries at surgery centers provides patients with the comfort of a calming environment with friendly staff that are dedicated to them. An additional benefit for the patient includes the safety of knowing that they are going home the same day from surgery.
Vik Mehta, MD. Hoag Hospital (Newport Beach, Calif.): Telehealth and outpatient spine surgery were two major adjustments in our practice that have continued after the COVID pandemic. Telehealth is a powerful tool that lets us engage better with patients by offering more convenient scheduling, the ability to have other family members involved and avoids the inconveniences of an office visit. There is no replacement for a thorough and in-person physical examination, but telehealth has allowed us to offer more access to patients, have better discussion and make sure our patients feel connected to us.
COVID accelerated many emerging trends, and the shift towards outpatient spine surgery was no exception. Telehealth, enhanced recovery paradigms, improved outpatient physical therapy, remote monitoring devices and reimbursement codes all together have allowed us to offer more outpatient spine surgery. Patients often recover better in their home environment with better sleep, less need for narcotics and more satisfaction. Ideal patient selection, particularly in older patients, is key for outpatient spine surgery.
Edward Perry, MD. Swift Institute (Reno, Nev.): We have many obstacles to overcome with patients after removing COVID restrictions, including the socioeconomic changes our patients experienced. Most notably, we have had to play an increasing role in encouraging patients to maintain their health and healthcare, especially in treating chronic diseases that affect surgery outcomes, like COPD, diabetes, obesity, and addictive behaviors, including smoking and alcohol-associated weight gain. We have also had to be more persistent in chasing down patients who fail to show up for appointments, complete their imaging workups, and get needed primary/specialty care risk stratification, including rotating checklists to ensure patients stay on track with their preoperative care. Finally, we have maintained patients' access to telemedicine; however, in a physical exam and image-driven specialty like neurosurgery, we have to help patients understand and comply when physical visits are required to prevent the "just treating the imaging" mentality that became pervasive during the COVID years. We continue to believe that the pandemic was just a speed bump in our careers but are still struck by how entrenched patients became in their habits during isolation.
Philip Schneider, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): The COVID-19 pandemic disrupted healthcare. Three years later, our practice has reverted back to pre-pandemic normalcy.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Aside from one's political assuage, the impact and fallout from this pandemic has had long-lasting ill effects as the system attempts to slowly "crawl back." From the initial shutdowns/ins and the holistic/cultural impact, it appears that having a paucity of deliverable care may have resurrected a new sense of appreciation imposed upon both patient and insurer. Albeit, the urgent/emergent disciplines were impacted less severely; graciously, our health system tirelessly accommodated the ebbing schedules. Fortuitous and appreciated.
There are so many changes and most seem immobile, yet the largest adjustment for our spinal practice has been in operative scheduling. Being able to work within strict parameters of time and personnel is always a negotiation, but one certainly worth the engagement. Point of fact is larger cities and practices have been more restricted even within the parent organization. My concerns lie in the future of healthcare delivery and its financial fitness, which seems to play out every quarter.