Dear CSS Members and Colleagues:
We are a small group, identified by an interest in problems of the shoulder and guided by the principles of EA Codman. Remember, he said “Give me something that is different, for there is a chance of it being better.” So, let’s consider an article which you can access via the link below:
Many of you may have seen this already ,and in this case, consider it in the context of what I say below. Here are just a few of the changes I think may affect healthcare going forward. Some are more likely than others and, no doubt, I have left many others off the list. I welcome your input.
Telemedicine & Virtual Visits will become the norm even for surgical specialties. Even before this terrible pandemic our group was doing a study in collaboration with Harvard Business School looking at the safety, clinical effectiveness & cost effectiveness of virtual visits during the 90-day post-acute care period following shoulder surgery. It was evident that patients who underwent rotator cuff repair as well as shoulder arthroplasty simply did not need to return to the office during this period and were very comfortable with a virtual visit. In fact, I could easily view their wound and instruct them how to self-examine themselves so I could know if there was an issue. Moreover, it was evident to me that the office capacity which this freed up would greatly affect the patient experience and cost-effectiveness of clinic utilization overall. I believe this kind of care will become the norm. I also think that we will screen many elective new patients this way in order to determine who can be treated without the need for an office visit, etc. I know many may say that is simply not possible or it is not safe. I disagree. Much of what we see in terms of patterns of complaint and common illnesses can be predicted without hands-on contact; furthermore, AI (Artificial Intelligence) algorithms will aid in the process. Finally, the regulatory barriers will be more movable as we have seen temporary suspension during the pandemic we currently face. For example, Insurance companies are more willing to pay equivalent value for virtual visits and office visits. Insurance and Board of Medicine Barriers are also suspended for the time being, so cross state consultations may become more of a reality without licensure barriers.
Utilization of Physical Therapy: We already knew that there is little evidence that more physical therapy for a given condition improves the ultimate recovery. This has been demonstrated in the Worker’s Comp space in terms of return to work. I believe PT surrogates through digital tools will innovate more guided programs of recovery for patients. Virtual coaching with feedback and YouTube videos, etc. will reduce the need for as much hands-on PT as we have come to expect. There are several examples of companies offering such options: https://ptgenie.com is an example. A general search, https://www.google.com/search?client=safari&sxsrf=ALeKk03lsWBz3e2tUSPzFVKGBxULOTQbOQ%3A1584822029669&ei=DXd2Xr-wKNKGytMP4JuZQA&q=virtual+physical+therapy&oq=virtual+physical+&gs_l=psy-ab.1.1.0l10.4720.7867..9999...0.0..0.1143.3234.12j0j3j1j7-1......0....1..gws-wiz.......35i39j0i30j0i8i10i30j0i22i30j0i273j0i131j0i67j0i10i273j0i10.RWRubyzwkBg , shows others.
On-line tools for postoperative recovery: We will create interactive modules either through third parties or through our own institutions which will concierge patients through their recovery. This may include Apps and websites with interactive input that identifies when patients need to return and see a caregiver. One example of such a company is http://myhealthtrack.com .
The Cost of Implants for Orthopedics and the Premium Pricing model will come under great scrutiny. This will also include high capital expense items. I think there will be a huge focus of the orthopedic implant industry on innovating their cost structure, and income statement, if you prefer, in order to drive margin more than revenue. At the end of this pandemic the healthcare system will be so depleted of capital that cost containment will be an essential driver of healthcare. Those companies which can adapt their supply chain and inventory needs to the system and manage their COGs (Costs of Goods) will be the winners.
Healthcare Education will change: Given the cost of travel and the pressure for catch-up we will have with all the “elective” care that has been unmet following the pandemic, virtual educational alternatives will become more widespread. Many organizations such as AAOS will offer more CME online virtual alternatives to meetings and travel. Educational organizations such as Vumedi (www.vumdi.com) will also step up educational opportunities with strategic collaborations with Industry and educational organizations inclusive of webinars and presentations. This shouldn’t surprise anyone.
What might surprise you is the impact of Virtual training using companies already just getting started. This included Precision OS (https://www.precisionostech.com ), OSSOVR (https://ossovr.com ), and Fundamental Surgery (https://www.fundamentalsurgery.com). These technologies will reduce cost of sales force education and also surgeon engagement and customer acquisition.
I’m sure you can each think of other areas of innovation. I would encourage you to look at business changes overall and extrapolate to healthcare. For too long, healthcare has been a carveout for inefficient use of time and money. I believe the future will not permit this in the USA any longer. Ask yourself how you can be part of this.
Kind Regards and Health to all of you,
“JP” Warner, MD