Evaluating Patient Interest in Orthopedic Telehealth Services Beyond the COVID-19 Pandemic.

Background Patient interest and demand may have an impact on dictating the scope of orthopedic telehealth utilization beyond the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to assess whether current interest in orthopedic telehealth services is higher than pre-pandemic levels. Specific trends in interest, subspecialty differences, and regional differences were secondarily assessed. Methodology A Google Trends search was performed to assess orthopedic telehealth search interest over the last five years using the terms "Orthopedic surgeon/doctor/injury/pain + Telehealth" as well as subspecialty-specific terms. The results were formulated into combined search interest values (CSIVs), with a maximum possible value of 400, and compared between the pre-pandemic period, pre-vaccine period during the pandemic, and post-vaccine period. Results The pre-pandemic period mean CSIV was 40.3 (SD = 6.3), compared to 134.7 (SD = 72.1) during the pre-vaccine period, and 96.3 (SD = 4.4) during the post-vaccine period (p < 0.001). There was a positive correlation between CSIV and time (increasing weeks) during the pre-pandemic period (rs = .77, p < 0.001) and no significant correlation between CSIV and time during the post-vaccine period (rs = -.12, p = 0.610). Using the slope of the interest line during the post-vaccine period (y = 97.06 - 0.08x) it would take an additional 13.3 years beyond the study period to reach the mean pre-pandemic CSIV level of 40.3. Hand surgery was the subspecialty with the highest mean CSIV over the study period and general search interest was highest in Northeastern and Southeastern states during the post-vaccine period. Conclusions Orthopedic telehealth interest was growing before the COVID-19 pandemic and remains significantly elevated beyond pre-pandemic levels despite the reopening of clinical offices and vaccine availability across the country. It appears that a subset of patients will continue to seek telehealth services beyond the pandemic.

Patient Perceptions of COVID-19 Precautions and Their Effects on Experiences With Hand Surgery.

PURPOSE: The purpose of this study is to evaluate patient perceptions of COVID-19 precautions and how these precautions have affected their hand and upper extremity surgery experience. METHODS: We sent an 18-item survey to 1,213 patients who underwent elective hand and upper extremity surgery at 1 academic institution from October 2020 to January 2021. The survey consisted of questions related to patient demographics, treatment delays due to COVID-19, and patient perceptions of COVID-19 precautions. Descriptive statistics were performed to analyze the survey responses. Responses for patients aged 18-50 and 51+ were compared using a chi-square analysis for categorical variables and a Student t-test for continuous variables. RESULTS: Out of 1,213 invitations, 384 survey respondents completed the survey (31.6%). Of the respondents, 16.8% reported delaying medical treatment for an average of 123.2 days because of COVID-19. The preventative measures were found to be adequate by 95% of patients. Only 2.6% of patients reported experiencing surgical delays due to preoperative COVID-19 testing or other COVID-19-related precautions. COVID-19 testing was seen as necessary by 88% of patients, and 74% did not find COVID-19 testing to be a barrier to their surgery. Patients aged 51+ were more likely to delay seeking medical treatment than younger patients (19.3% vs 9.1%, respectively). Furthermore, those that did delay seeking treatment waited longer on average than their younger counterparts (136.1 vs 72.9 days, respectively). CONCLUSIONS: In conclusion, patients undergoing hand and upper extremity surgery typically do not find COVID-19 precautions to be a significant barrier to care and understand their importance. Despite this, many patients, particularly older ones, are delaying medical care for extended periods of time. It is important for hand surgeons to acknowledge their patients' perspectives and work to educate patients on evolving surgical safety guidelines. CLINICAL RELEVANCE: Patient perspectives of current COVID-19 precautions can help inform hand surgeons on areas for continued patient education.

The Financial Implications of Telehealth Visits Within a Hand and Wrist Surgery Clinical Practice During the COVID-19 Pandemic.

PURPOSE: Telehealth use is likely to increase as a result of practice changes during the COVID-19 pandemic, although the overall picture surrounding the billing, coding, and continued insurance coverage of these visits remains uncertain. The purpose of this study was to identify potential financial implications of continued telehealth use in hand and wrist surgery clinical practice. METHODS: Two hundred telehealth visits were randomly selected and matched 1:1 based on primary diagnosis code to in-person visits. Medical and billing records were reviewed to compare visit complexities, total visit charges, work relative value units (wRVUs), and approved insurance reimbursement. Postoperative visits and visits with radiographic evaluation were excluded. RESULTS: Level 4 visits were more common with in-person encounters compared to telehealth (11% vs 2%, respectively), and level 1 and 2 visits were more common with telehealth compared to in-person encounters (14% vs 6%, respectively). Twenty-seven in-person visits (13%) had at least 1 additional procedure code billed. The mean total visit charge was 26% less in telehealth compared to in-person. Based on the primary procedure code alone, the sum of wRVUs was 15.1 points less in the telehealth cohort compared to in-person (per visit average, 1.1 [telehealth] vs 1.2 [in-person]). The 28 additional services provided during in-person visits accounted for an added 20.7 wRVUs. Unpaid claims were more common among telehealth encounters (8% [telehealth] vs 3% [in-person]). CONCLUSIONS: Higher complexity visits and visits with additional procedural codes billed were more common with in-person visits. This led to a lower number of total wRVUs and lower total visit charges among the included telehealth visits compared to the matched in-person controls. CLINICAL RELEVANCE: It is important to understand and consider the long-term financial impact of telehealth implementation. Practices must develop strategies to incorporate radiographic evaluation into telehealth visits and effectively stratify those patients that may require procedural interventions for in-person visits. Understanding the economic implications of this changing care delivery paradigm, providers can continue to provide telehealth services while protecting the financial sustainability of hand surgery practices.

Safety and Efficacy of Casting during COVID-19 Pandemic: A Comparison of the Mechanical Properties of Polymers Used for 3D Printing to Conventional Materials Used for the Generation of Orthopaedic Orthoses.

To reduce the risk of spread of the novel coronavirus (COVID-19), the emerging protocols are advising for less physician-patient contact, shortening the contact time, and keeping a safe distance. It is recommended that unnecessary casting be avoided in the events that alternative methods can be applied such as in stable ankle fractures, and hindfoot/midfoot/forefoot injuries. Fiberglass casts are suboptimal because they require a follow up for cast removal while a conventional plaster cast is amenable to self-removal by submerging in water and cutting the cotton bandages with scissors. At present, only fiberglass casts are widely available to allow waterproof casting. To reduce the contact time during casting, a custom-made 3D printed casts/splints can be ordered remotely which reduces the number of visits and shortens the contact time while it allows for self-removal by the patient. The cast is printed after the limb is 3D scanned in 5-10 seconds using the commercially available 3D scanners. In contrast to the conventional casting, a 3D printed cast/splint is washable which is an advantage during an infectious crisis such as the COVID-19 pandemic.