How to sustainably resume elective total joints: A road map from Drs. Richard Iorio, William Healy & more


A new paper in The Journal of Arthroplasty outlines six economic pillars required to successfully and sustainably restart elective orthopedic surgeries during the COVID-19 pandemic.

Titled "Economic Recovery After the COVID-19 Pandemic: Resuming Elective Orthopedic Surgery and Total Joint Arthroplasty," the paper was written by Casey O'Connor, MD, Afshin Anoushiravani, MR, Matthew DiCaprio, MD, William Healy, MD, and Richard Iorio, MD.

"The return to normalcy will be slow and may be different than what we are accustomed to," the authors wrote, "but we must work together to plan a transition to a more sustainable healthcare reality which accommodates a COVID-19 world."

The six pillars for successful reintroduction of elective orthopedics:

1. Patient demand for elective surgery. Practices should assess post-crisis demand by asking patients directly whether they'd like to reschedule. Demand may be affected by patients' loss of employer-sponsored health insurance and fears about contracting COVID-19. Practices should plan staff and resource utilization based on projections three to six months in advance.

2. Evidence-based practices. Practices are advised to optimize preoperative processes to ensure quality outcomes; follow local and federal COVID-19 testing recommendations for elective cases; consider delaying surgery for total joint candidates with significant non-modifiable risk factors; and aim to reduce postoperative complications.

3. Early discharge and outpatient surgery. Restarting elective surgeries will require practices to follow strict patient selection and screening criteria, with thorough preapproval processes in place. Healthcare groups should consider extending rapid recovery programs for total joint patients to meet higher demand, and CMS should consider eliminating hospital-based reimbursement penalties.

4. Technology and innovation. Orthopedic providers can use telemedicine to improve efficiencies, invest in HIPAA-compliant technology and implement new training protocols to help with workload distribution for constricted teams.

5. Contracts and vendors. Practices may lower implant costs by renegotiating contracts. They should also establish specialized negotiating committees and consider refinancing or negotiating new terms for office space. The use of nonessential technologies should be reevaluated.

6. Government programs. Orthopedic groups are encouraged to look into getting aid from the U.S. Small Business Administration and to apply to programs for which they're eligible. Additionally, orthopedic practices and health systems should avoid accumulating unsustainable debt.

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