Obstacles for Orthopedic Care through Q4 2020

Orthopedic Care Due to the COVID-19 Pandemic will Require a Laser-focused Solution

In a few short weeks, the COVID-19 pandemic has effectively brought nonurgent orthopedic care in the United States to a halt. Elective surgery has been essentially banned for an indeterminate period of time. Due to concerns of virus spread and social distancing, routine office visits are no longer an option. Most orthopedic surgical practices are limiting patient visits to urgent visits only. Certainly, teleconferencing has allowed for additional patient contact; however, it is not providing the volume of patient visits as seen pre-pandemic. These are unprecedented times, severely limiting the ability of orthopedic surgeons to provide operative and non-operative care for their patients.  

Supply Chain Fragility

As orthopedic surgeons across the country anxiously await the resolution of the COVID-19 pandemic, the patients requiring elective surgery continue to mount. The premise is once the pandemic is under control, we will work overtime to make up for lost time. Surgery centers will stay open late and on weekends to allow surgeons to operate as much as possible to reduce the backlog of elective surgery. Unfortunately, the fragility of our surgical supply chain will not be able to support the rapid plan for surgical escalation. The majority of our disposable surgical goods, including drapes and personal protective equipment are manufactured in China. In an article by Lizzie O’Leary in the Atlantic, Doug Watkins, who oversees the supply chain at the Medical University of South Carolina Health System, explains, “We have built a global supply chain that runs on outsourcing and thin margins.” The COVID-19 pandemic has exposed significant supply chain weaknesses. Despite our desire to kick-start elective surgical volume, we are going to be limited by the amount of supplies our hospital systems and ambulatory surgery centers can procure. This will limit surgical volume even further, perpetuating the elective surgical burden. 

Elective Surgical Backlog

As every week passes in this pandemic, more elective surgery will be cancelled. Many busy arthroplasty surgeons are booked out 3 to 6 months for joint replacement. It is possible that nonurgent cases may be on hold for an additional 4 to 6 weeks. This means as many as 20 patients per week per physician are being postponed and added to the surgical queue. Vinod Dasa, MD, Vice Chair of Academic Affairs at LSU Health Sciences Center, Department of Orthopedics stated,

“Given most total joint surgeons were at maximum capacity pre-COVID-19, and many were not able to meet existing demand, it may be 18 months or more before the backlog can be completely addressed. Additionally, if there is no additional capacity (more surgeons, more ORs to flip rooms, or additional block time), that time may be even longer. Remember that all the other surgical specialties (ortho and non-ortho) are in the same position asking for the same resources as orthopedics and total joints.”

As previously stated, supply chain shortages compound the backlog by limiting the number of cases that can be performed. It will take an indeterminate period of time for manufacturers to ramp up surgical supply delivery. This will potentially reduce the number of cases that can be done on a weekly basis. Basically, there will be more patients that need surgical intervention with less availability. This will effectively create a backlog of elective surgical cases for months. 

Reduced Surgical Revenue 

Most orthopedic surgeons generate a significant portion of their income from surgical revenue from the professional component of the surgical fee. Ron Gigliodoro, President of Professional Management Associates, who manages over 35 orthopedic practices explains, “Orthopedic surgeons generate between 30 to 70 percent of their income through surgery. There are several factors that will limit surgical revenue, including supply chain limitations, patients’ desire to return to work rather than undergo surgery, and OR availability. I can see physician revenue from surgery affected into 2021.”

With the existing elective surgical ban, surgical revenue will be drastically reduced for hospital systems, ASCs, and surgeons indefinitely. Additionally, surgeons that have ownership stake in ASCs will see reduction in ownership profits. With decreased revenue, most orthopedic practices are looking to reduce expenses, as they do not have cash reserves. This has led to massive furloughs and layoffs for valuable practice employees. With reduced staffing, there is less ability to provide care for routine acute and chronic orthopedic conditions. Another factor reducing surgical procedures and potential revenue will be the rising effects of unemployment. Hopefully, as the epidemic wanes, temporary furloughs will be lifted, and people will return to work. The question becomes will people consider elective surgery soon after a return to work. There is a real possibility that actively employed patients will seek alternatives to surgery to resume work and recover personal income lost. This action may again reduce the need for elective surgery, further reducing physician income. The lingering effects of the epidemic potentially creates a cycle of limited patient access, reduced desire for surgery for the active population, delayed surgery for the elderly, and reduced physician income. 

Alternative Treatment/Revenue Options

These are challenging times for the care of acute and chronic nonurgent orthopedic conditions. As outlined above, there are numerous obstacles for orthopedic surgeons and hospital groups to care for their patients. The problem as outlined is prolonged elective surgical queues, reduced surgical income for physicians and hospital groups, and the need for alternative pain management solutions to accommodate patients who are not undergoing surgery. Active patients will be searching for alternative nonsurgical pain management options that keep them in the work force. Older patients with prolonged surgical wait times will also seek solutions for pain relief while waiting for surgery. Several alternative longer acting treatment options are available for osteoarthritis knee pain such as, Zilretta a novel long acting intra articular corticosteroid injection, as well as IOVERA a cryotherapy axotnomesis device, but both are limited to the knee joint.

The solution is to identify alternative affordable and effective nonsurgical treatment options for a broad range of acute and chronic orthopedic conditions that can generate additional revenue streams for clinical practice. As Chief Medical Officer of OrthoLazer Orthopedic Laser Centers, I believe that robotic laser therapy specifically delivered with the M8 MLS Laser can help fill the void of lost physician revenue, and provide an effective alternative treatment option for patients with acute and chronic pain. Our franchise model allows physician ownership with direct patient referrals. There are no federal Stark Law implications, as laser therapy is not a designated health service per CMS guidelines. Currently, there are multiple OrthoLazer Orthopedic Centers across the country proving the model. Expansion is moving forwards with two more OrthoLazer Centers per month coming online. OrthoLazer Orthopedic Laser Centers can provide a practical financial and alternative patient treatment solution for orthopedic surgeons and their business partners. For more information, please tap the link box below labeled HOME.