Point/Counter

In what ways will telemedicine change how orthopedic surgeons deliver care in the next 2 to 5 years?

Click here to read the Cover Story, "Orthopedists start to adopt virtual continuity of care."

POINT

Telemedicine will improve accessibility

Sara Foster, PA-C
Sara Foster

As telemedicine gains increased popularity, we are recognizing its unique potential to extend services to patients with orthopedic needs throughout underserved and rural communities or in surrounding states. An infected hip or knee is an intimidating and stressful potential complication after joint replacement. Acute trauma, cancer and pediatric diagnoses are other complex and serious orthopedic problems that many patients face. Fortunately, there are great specialists and tertiary centers that can handle the most complicated orthopedic cases. But this often involves surgery with frequent trips to a central location for follow-up, and travel expense and planning adds to patient and family stress. Even when a patient can access the orthopedic surgeon or the orthopedic team with a phone call, it is difficult to evaluate a patient by phone who has concerns about a wound or function after surgery. In the next few years, a telemedicine visit could replace an office visit and contain health care costs by preventing unnecessary trips to the ED, reduce hospital readmissions and improve patient satisfaction by catching problems earlier.

On the other end of the spectrum, some patients do so well after surgery that they are ready to return to work and get back to their lives sooner than expected. For them, taking a day off for a doctor’s visit seems wasted, but they would still like to touch base and see their surgeon or a physician assistant or advanced practice registered nurse. As the orthopedic world works to implement telemedicine services, the goal is to provide increased access to health care services to patients that connects with them in their own homes via their computers and smartphones without sacrificing the quality of their care. Orthopedic surgeons offer vital and unique services, and we all need to work harder to make these services more accessible to patients who need them.

Sara Foster, PA-C, is in the department of orthopedic surgery at College of Medicine at University of Arkansas for Medical Sciences in Little Rock, Arkansas.
Disclosure: Foster reports no relevant financial disclosures.

COUNTER

“Treat the patient, not the X-ray!”

Joshua D. Harris, MD
Joshua D. Harris

Orthopedic telemedicine has the potential to greatly benefit patients, providers and payers, but it is not without significant limitations and liabilities. Over the next 5 years, telemedicine may continue to integrate into preoperative and postoperative care for orthopedic surgery patients, but there are barriers. Providers may participate in a digital face-to-face history, an imaging review and a discussion of treatment options. The obvious omission is the physical exam.

In orthopedics, providers must, “Treat the patient not the X-ray!” as Peters and colleagues noted. Some clinicians may be able to accurately diagnose certain conditions (eg, traumatic tibia fracture, osteosarcoma) with a radiograph alone. However, the high prevalence of asymptomatic, abnormal imaging findings with other conditions, such as the degenerative disc in low back pain, rotator cuff tendinopathy in shoulder pain, medial meniscus tears in knee pain, labral tears in hip pain, mandate a physical examination be done to corroborate the symptom’s source. This self-selects certain subspecialties, such as trauma and oncology, as better suited for telemedicine and other subspecialties as less well-suited, including sports medicine and spine. Postoperative checks, especially in the first 90 days, may also easily be facilitated by telemedicine. This will reduce in-office postoperative visits by patients already covered during the global period and improve efficiency.

Orthopedic surgeons may immediately respond with concerns about how to bill an office visit that lacks a physical exam. An arbitrary cost may be assigned, but no value is achieved for employed providers whose productivity may be based on work relative value units. Additionally, the frustrations associated with the IT component of the digital consult done without office support staff — internet speed, microphone, complete chart access, imaging review — may supersede any potential benefits.

Telemedicine opportunities include ease of subspecialist access, easier postoperative evaluations, decreased travel burden for out-of-town patients, marketing and an increased proportion of actual in-office patient visits being surgical in nature. However, the current drawbacks preclude the widespread, mainstream use of telemedicine in orthopedic surgery in the next 5 years.

Joshua D. Harris, MD, is an orthopedic surgeon at Houston Methodist Hospital in Houston.
Disclosure: Harris reports no relevant financial disclosures.

Click here to read the Cover Story, "Orthopedists start to adopt virtual continuity of care."

POINT

Telemedicine will improve accessibility

Sara Foster, PA-C
Sara Foster

As telemedicine gains increased popularity, we are recognizing its unique potential to extend services to patients with orthopedic needs throughout underserved and rural communities or in surrounding states. An infected hip or knee is an intimidating and stressful potential complication after joint replacement. Acute trauma, cancer and pediatric diagnoses are other complex and serious orthopedic problems that many patients face. Fortunately, there are great specialists and tertiary centers that can handle the most complicated orthopedic cases. But this often involves surgery with frequent trips to a central location for follow-up, and travel expense and planning adds to patient and family stress. Even when a patient can access the orthopedic surgeon or the orthopedic team with a phone call, it is difficult to evaluate a patient by phone who has concerns about a wound or function after surgery. In the next few years, a telemedicine visit could replace an office visit and contain health care costs by preventing unnecessary trips to the ED, reduce hospital readmissions and improve patient satisfaction by catching problems earlier.

On the other end of the spectrum, some patients do so well after surgery that they are ready to return to work and get back to their lives sooner than expected. For them, taking a day off for a doctor’s visit seems wasted, but they would still like to touch base and see their surgeon or a physician assistant or advanced practice registered nurse. As the orthopedic world works to implement telemedicine services, the goal is to provide increased access to health care services to patients that connects with them in their own homes via their computers and smartphones without sacrificing the quality of their care. Orthopedic surgeons offer vital and unique services, and we all need to work harder to make these services more accessible to patients who need them.

Sara Foster, PA-C, is in the department of orthopedic surgery at College of Medicine at University of Arkansas for Medical Sciences in Little Rock, Arkansas.
Disclosure: Foster reports no relevant financial disclosures.

PAGE BREAK

COUNTER

“Treat the patient, not the X-ray!”

Joshua D. Harris, MD
Joshua D. Harris

Orthopedic telemedicine has the potential to greatly benefit patients, providers and payers, but it is not without significant limitations and liabilities. Over the next 5 years, telemedicine may continue to integrate into preoperative and postoperative care for orthopedic surgery patients, but there are barriers. Providers may participate in a digital face-to-face history, an imaging review and a discussion of treatment options. The obvious omission is the physical exam.

In orthopedics, providers must, “Treat the patient not the X-ray!” as Peters and colleagues noted. Some clinicians may be able to accurately diagnose certain conditions (eg, traumatic tibia fracture, osteosarcoma) with a radiograph alone. However, the high prevalence of asymptomatic, abnormal imaging findings with other conditions, such as the degenerative disc in low back pain, rotator cuff tendinopathy in shoulder pain, medial meniscus tears in knee pain, labral tears in hip pain, mandate a physical examination be done to corroborate the symptom’s source. This self-selects certain subspecialties, such as trauma and oncology, as better suited for telemedicine and other subspecialties as less well-suited, including sports medicine and spine. Postoperative checks, especially in the first 90 days, may also easily be facilitated by telemedicine. This will reduce in-office postoperative visits by patients already covered during the global period and improve efficiency.

Orthopedic surgeons may immediately respond with concerns about how to bill an office visit that lacks a physical exam. An arbitrary cost may be assigned, but no value is achieved for employed providers whose productivity may be based on work relative value units. Additionally, the frustrations associated with the IT component of the digital consult done without office support staff — internet speed, microphone, complete chart access, imaging review — may supersede any potential benefits.

Telemedicine opportunities include ease of subspecialist access, easier postoperative evaluations, decreased travel burden for out-of-town patients, marketing and an increased proportion of actual in-office patient visits being surgical in nature. However, the current drawbacks preclude the widespread, mainstream use of telemedicine in orthopedic surgery in the next 5 years.

Joshua D. Harris, MD, is an orthopedic surgeon at Houston Methodist Hospital in Houston.
Disclosure: Harris reports no relevant financial disclosures.