Surgery has undergone a great deal of fluctuation amid COVID-19 pandemic. As the country grappled with a relatively unknown virus and raced to learn more about it, hospitals suspended elective and nonurgent surgeries. In some cases, operating rooms were co-opted for COVID-19 care. But as states reopened, surgery service lines did as well, and now many organizations are working to adjust surgery services to the new normal.
In a webinar, hosted by Becker's Hospital Review and sponsored by Empiric Health, a panel of physician leaders discussed the key opportunities and challenges facing surgical services in the age of COVID-19. Becca LaFond, COO of Empiric Health, moderated the discussion.
The panelists included:
● David E. Skarda, MD, senior medical director of the center for value-based surgery at Intermountain Healthcare in Salt Lake City
● Nick Mickas, MD, medical director of clinical operations at John Muir Health in Walnut Creek, Calif.
● Ashok Rai, MD, president and CEO, Prevea Health, Hospital Sisters Health System in Green Bay, Wis.
● Simon Payne, MD, CMO, clinical and operational transformation at SCL Health in Broomfield, Colo.
Here are five key thoughts from the discussion, edited for length and clarity:
Dr. Skarda on achieving strategic value improvement goals in 2020:
"The reduction in surgical volume has had a very significant financial impact on the bottom line for Intermountain Healthcare. Nevertheless, we went into 2020 with some very specific goals regarding value improvement. And in some strange and oblique ways, the events of 2020, involving COVID-19, have actually really helped us move down those paths of improving value in ways that we really were not anticipating. For example, a reduction in volume provided us with an opportunity to really evaluate carefully where we were doing certain procedures in the system."
Dr. Payne and Dr. Rai on the rapid adoption of telehealth and its benefits:
Dr. Payne: "We were very slowly, I mean really slowly, moving toward telehealth and in a matter of weeks, we went from a single digit percentile of our visits being telehealth to more than 50 percent. There is a cohort of patients who not only expect that care but prefer that care. And we've found providers actually who may prefer that care. It allows for some more flexibility and potentially some work-life balance from a physician perspective too because some of those [services] with the technology we have can actually be completed from home."
Dr. Rai: "I think the populace, our patients, our communities are 1,000 times more comfortable with what we're doing right now because this is how they're going to school. This is how they're working. So, we needed two components to happen to really drive telehealth. No. 1, [we needed] our platforms and providers to be ready. [We also needed] society to recognize this as an appropriate way to not only provide care but to interact with each other."
Dr. Mickas on physician camaraderie amid the pandemic:
"The dialogue that's happening amongst our physician community is in a different place than it's ever been before. When we initially shut down the ORs, our trauma surgeons came and said 'OK, so how can we help with the ICUs?' And one of the things that happened on that very organic level was they made themselves available as a procedure panel. So that if we needed to talk about tracheostomies, needed to talk about emergent access to free up our intensivists, the trauma surgeons made themselves available to basically provide procedure. So I think that camaraderie and that conversation around how we all need one another — now is the time to capitalize on that."
Dr. Rai on the future of surgery post-pandemic:
"Really looking at the word surgery, since the beginning of it being modernized, it's always been tied to the word hospital. And I think 2020 and the crisis, and other things going on economically, are going to forever change how those two words [are tied]. They are likely not going to be as tied together or not tied together at all going forward. And I think physicians specifically, through need and through innovation, will drive this the most. I think hospitals will always have an OR, but surgery will not be headquartered there. That's one thing that 2020 has taught us — those who were able to maintain some sort of financial viability and were able to better take care of their patients had options that others didn't."