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Background Telehealth platforms may save resources for patients and providers, but the precise impact of their incorporation during the postoperative period is not well understood. The goal of this study is to determine whether telehealth incorporation in the postoperative period leads to an overall increase in healthcare utilization after upper extremity surgery. Methodology Patients seen for a postoperative telehealth visit after upper extremity surgery were randomly selected and retrospectively enrolled. Complications and the total number of postoperative visits before clinical discharge were recorded and compared to controls matched by surgery type and surgeon. Results A total of 56 patients were seen for 60 telehealth visits. The most common surgical procedures were distal radius open-reduction internal fixation (n = 8), open carpal tunnel release (n = 8), and endoscopic carpal tunnel release (n = 6). One telehealth visit (1.7%) required conversion to in-person evaluation due to suspected superficial infection necessitating in-person physical examination. The average number of postoperative visits prior to clinical discharge was 2.6 in the telehealth group compared to 2.7 in matched controls (p = 0.886). Complication rates were similar between groups. Conclusions The rate of necessary in-person evaluation after postoperative telehealth visits was less than 2%. The incorporation of telehealth visits did not appear to increase healthcare utilization after upper extremity surgery. Accordingly, the postoperative period is likely an ideal application for safe and effective telehealth implementation.
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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.
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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.