Is the virtual orthopedic visit here to stay after the COVID-19 pandemic?
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Depends on type of visit
This is going to be predicated on the three different types of visits for orthopedics.
We have the initial visit where we meet the patient, we get to know them, establish a rapport and do a diagnosis, which can include physical exam, radiographs and advanced studies. That new visit is essential to us to establish a relationship with the patient, so that new visit will continue to need to be done primarily in person. Regarding the follow-up visits, and even the postoperative visits, we’ve learned as a result of the COVID-19 pandemic, our lockdowns and our new visits that follow-up visits can often be simplified and expedited by a virtual visit. You already know the patient, you have some rapport established, you have some empathy and you have a connection. Therefore, it is not as essential that we hold a follow-up visit in person as it once was.
The virtual visit is also changing some of the ways we manage postoperative care. Do we use boots vs. casts? Can we apply subcuticular closures vs. staples or sutures? Some of the ways we can do a surgical procedure that allow us to do a postoperative visit in the virtual mode will, of course, depend on the specialty and the surgeon. However, I think the virtual visit is valuable and a good way to monitor wound healing and other postoperative care.
When we feel comfortable with a virtual visit, it often gives us more time because scheduling allows virtual visits to be held in a simpler, more modular time frame. We can also sit down and go right to the exam. Although we are limited by the format of the visit, we realize that we can do some work this way and some publications have discussed the physical exams that we can do. For example, patients can also do an assisted exam and, in many ways, help the orthopedic surgeon.
Virtual visits are efficient because patients don’t have the facility fees, from a cost perspective, and don’t need to take time out of their busy days to come to the clinic. I have found that one of the values of the virtual visit is that patients are satisfied and they have an expectation that you’re right on time. Although we must measure and monitor this, I think it’s an important reason the virtual visit will continue.
James R. Ficke, MD, FACS, FAAOS, is the Robert A. Robinson Professor and chair of the department of orthopedic surgery at Johns Hopkins Medicine in Baltimore.
Increased access to care
Yes, I believe that virtual orthopedic visits will be useful and utilized after the COVID-19 pandemic. The benefits of advancing patient care and providing access to care are outstanding for patients. It offers supreme access and a convenient opportunity for patients to better utilize their time without the need for travel to the office for care. The primary challenge is ensuring that insurance companies continue to recognize these services as reimbursable. While the entire spectrum of orthopedic care delivery cannot be done with telemedicine, an abundant amount of care, such as postoperative and follow-up appointments, can be completed via telemedicine. In addition, new patient evaluations can also be accomplished as our telemedicine platforms and capabilities, both on the provider and the patient side, continue to evolve. These platforms will continue to offer value to both the patient, the provider and the carrier by increasing access to efficient comparable care for many orthopedic conditions both new and established.
Lawrence Wells, MD, is an associate professor of orthopedic surgery and vice chair of inclusion, diversity and equity in the department of orthopedic surgery at Perlman School of Medicine; associate director of sports medicine and associate chair of inclusion, diversity and equity in the department of surgery at Children’s Hospital of Philadelphia; and an Orthopedics Today Editorial Board Member.
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