COVID-19: How Orthopedic Clinicians are Leveraging Remote Healthcare
As the COVID-19 pandemic moves to the forefront, we wanted to reach out to the medical orthopedic community and see how they're handling this new reality. To understand the current climate for surgeons and how they're navigating this challenging time, we spoke with Los Angeles-based orthopedic surgeon, Dr. Nima Mehran MD. We wanted to better understand how this global pandemic is affecting surgeries, elective procedures, in-person visits, and the ways he and his colleagues are continuing to treat patients.
As things are changing quickly, it should be noted that our interview with Dr. Mehran took place on March 20th, 2020. This was the same week that Centers for Medicare & Medicaid Services (CMS) recommended all elective, non-essential surgeries be delayed.
Why Elective Surgeries and Orthopedic Appointments Are Being Cancelled
To aggressively address COVID-19, CMS has released recommendations for adult elective surgeries across the country. In their recommendations, CMS has ranked the tiers of various surgery types, filing most orthopedic surgeries in the "consider postponing surgery" category. Other more critical and time-sensitive elective surgeries relating to cancer, neurosurgery, transplants, limb threatening and traumas are still moving forward with urgency. In other words, if it's not life threatening or needs immediate intervention, surgeons and hospitals are opting to cancel or postpone.
So why are regular life-improving orthopedic surgeries being cancelled? What about regular visits for those with musculoskeletal conditions, injuries, or chronic pain? Dr. Mehran summed it up simply, "Considering the current climate, we don't want to put anyone at risk. For the majority of orthopedic care, going to the hospital doesn't make sense when dealing with chronic injuries, pain, or nagging inflammation, tendonitis and so forth."
At a glance, here's why surgeries (and in-person care) is being cancelled:
"The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight."- CMS Administrator Seema Verma
Adding risk without the urgency. Physical therapy appointments, in-person consultations, and non-immediate surgeries are being postponed to reduce the spread, and to protect healthcare workers, and patients going into facilities who's treatment may not be optional.
Need all (and beds) hands-on-deck. Considering staffing levels, number of ventilators, supply of PPE, and bed availability, is critical. Putting off non-essential surgeries, procedures, and appointments creates room for the influx of COVID-19 patients and other urgent cases.
Telehealth treatment is effective. Less urgent patients aren't being left 'high and dry'. Those living with pain and mobility issues, who've experienced a musculoskeletal injury, or who were long-awaiting an orthopedic surgery can still improve their condition from home. With remote healthcare, care teams can offer advice, diagnose conditions, triage who may need immediate medical attention, offer prescriptions, and give physical therapy and other at-home solutions to manage conditions and prepare for an upcoming procedure.
"We need to decrease the viral load and the viral spread. Going into the hospital or maintaining appointments puts themselves and others at risk...Plus, there's so much we can do from home."- Dr. Mehran, MD.
How Orthopedic Healthcare Teams Are Adjusting to COVID-10: Enter Remote Healthcare
When asked how Dr. Mehran and his colleagues are adjusting to greatly reduced in-person meetings and postponed orthopedic surgeries, Dr. Mehan spoke to how much providers and patients can still be doing to achieve the desired outcomes. Specifically, the level of effective medical guidance healthcare teams can offer through digital health and how much patients with musculoskeletal disorders (MSDs) can do from home to improve their condition, has really been underscored throughout this crisis.
Dr. Mehran explains, "Through telehealth appointments, I'm finding myself able to diagnose a lot. I can coach patients who are experiencing pain and mobility issues, and triage who is more urgent and needs to be seen right away."
Orthopedic care teams are still able to determine through real-time telecommunications which patients are critical. These patients are then triaged by their care providers and sent for imaging, or possibly put through for immediate surgery. However, for the majority of musculoskeletal patients, injured workers with an MSD, or those who've long awaited orthopedic surgery to treat their pain or mobility issues, they are being prescribed at-home treatments.
"There's so much that patients can be doing at home. Through video chats and phone calls, we have patient history of their ailments. We can let the patients describe pain and symptoms, and offer advice and non-operative management from home," adds Dr. Mehran.
"When I talk to a new patient over the phone instead of in person I can recommend exercises, helpful videos, discuss important factors like weight loss, and order anti-inflammatories if necessary. The patient is still getting something out of it and we can make plans for the future" explained Dr. Mehran.
As for not being able to see the patient in-person to physically examine them? Dr. Mehran says that he and his colleagues have been surprised by how much can still be accomplished through remote medicine. For instance, a lot of older patients with arthritis and chronic issues will have X-rays already in the system. "Oftentimes we have imaging for adults with knee arthritis or pain. Even if the X-rays are from a few months or even years ago, we can still properly identify the issue and recommend courses of treatment," said Dr. Mehran. Dr. Mehran adds, "I'm learning that the inaccuracies of not being able to physically put your hands on a patient isn't as dramatic as you think."
Pros of Remote Healthcare for Orthopedic Patients During COVID-19 (and Beyond):
To continue offering medical treatment and support for non-urgent patients throughout the COVID-19 crisis, who may have questions or need a regular appointment, CMS is leaning heavily on telehealth. The Centers for Medicare & Medicaid Services and state governments have acted quickly to roll-out new telehealth recommendations and regulations, loosened licensure, and allowed for more liberal billing and cost-sharing.
"With the emergence of the virus causing the disease COVID-19, there is an urgency to expand the use of technology to help people who need routine care, and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they need."- Centers for Medicare & Medicaid Services
The extended telehealth Medicare coverage and payment for virtual services covers both new and existing patients. As regulations are changing quickly, as a care provider, please contact your state board of medicine or department of health for the latest information.
Key Benefits of Digital Health (Today and Tomorrow):
More Accessible: With in-person appointments being cancelled, telehealth allows healthcare providers to continue to safely check-in on their patients. Dr. Mehran shared that through video calling he was still able to meet with up to 25 orthopedic patients each day. Digital health is more accessible for both providers and patients.
Can Still Treat Patients: Although in-person treatments like steroid injections, imaging, and surgery may be off the table, patients are still offered guidance. Patients are given tools to improve pain and mobility from home, and can even begin to optimize for an upcoming surgery. The more a patient prepares for musculoskeletal surgery, the lower their risk and faster their recovery will be. This "downtime" is an opportunity for patients to improve their condition and steer their medical outcomes.
Triage Who Must be Seen: Urgent patients still need to be seen in-person and telemedicine lets care providers determine who those patients are. Telemedicine aims to provide high quality, effective, accessible care regardless of location. Dr. Mehran explains, "During my telehealth appointments I am able to diagnose a lot, coach my existing patients, and triage anyone who needs to be seen right away."
Offer Real Take-Aways: It's been proven that those living with musculoskeletal disorders (like arthritis, tendonitis, rotator cuff injuries, etc.) can dramatically increase their mobility, reduce pain, and steer their own recovery. Offering patients digital musculoskeletal PreHab and ReHab that offers at-home physical therapy, improves health literacy, teaches nutrition, helps emotional health, etc., means that patients are empowered outside of outpatient appointments.
Better Communication?: An interesting take-away that Dr. Mehran shared that telemedicine makes him a "better listener". Dr. Mehran explains, "During a phone call, I am a much better listener. Because I don't have the access to a physical exam, I am paying much closer detail to the words they're using, how they're describing their condition and the types of pain they're experiencing. On the other side, some of my medical advice seems to land better. For instance, when you talk about weight loss with a patient in-person it can come across as a criticism when it is not. Over the phone, I can offer this sort of medical advice with more neutrality."
By making digital health solutions and virtual services more accessible and attractive to providers, patients are able to get the medical guidance they need. The need for remote healthcare, today and tomorrow, has never been more apparent. The accommodations being made at the federal and state level to roll out digital healthcare is unprecedented and we believe marks a fundamental shift in how care is delivered and received.
Are you interested in offering musculoskeletal digital solutions to your patients, claimants or employees? Learn more.