A View of the COVID-19 Pandemic from Joseph Mathews of Advanced Orthopaedics & Sports Medicine

By Joseph Mathews, DPT and Krista Armstrong
Advanced Orthopaedics & Sports Medicine

The COVID-19 crisis has created unprecedented burdens on our American way of life as we know it.  The healthcare burden is obvious—as of today over 392,000 Americans have tested positive, and over 12,370 have died.  The social burden is also easy to see—eating out at restaurants, shopping, travel and spending time with friends and family have all been put on hold.  The economic burden of this crisis, however, is still unfolding.

This past week the U.S. Department of Labor reported 6.65 million new jobless claims, the highest ever on record, eclipsing easily the previous record of 695,000 reported on October 2, 1982.  The stock market has dropped over 25 percent, and trillions of dollars have been lost from pension and retirement plans.

As a part of the COVID response Governor Greg Abbott issued an executive order on March 22 that prohibits non-emergent, elective surgical cases until April 21 (pending further action). While many orthopedic surgeries are emergent, this order impacted our practice significantly. We have witnessed a 90 percent reduction in surgeries. Fear of contracting the virus and shelter in place orders in Harris County also led to a 50-60 percent reduction in clinic patient volume. This has led to a downstream effect on referrals to ancillary services like DME, physical and occupational therapy.

Yet, Advanced Orthopaedics & Sports Medicine, like so many other practices, has been faced with the daunting task of managing our healthcare environment within the context of COVID-19 and all the daily changes and challenges it brings. We had to balance the safety and health of our patients and staff with the need to meet our financial obligations. With so many variables we cannot control, here is the reality we have faced and the solutions and sacrifices we have all made during this pandemic.

We have remained committed to the safety of our patients and employees and also to keeping our doors open as long as we are able. We implemented mandatory COVID screenings during appointment booking and at our office locations, placed alert notices on all entry doors, and began triage in the lobby before moving to the check-in desks including temperature checks and the recommended questions as directed by the CDC. We reassigned staff and implemented a thorough cleaning schedule at all locations including waiting room furniture, counter spaces, frequently touched items, door knobs, and other equipment. Telemedicine was offered to patients canceling appointments, those at risk, concerned about exposure or who answer positively to any of the COVID-19 screening questions.

Telemedicine was implemented for established follow-up and post-op visits and is expanding to new patients using Doxy.me. We have converted our patient documents to fillable PDFs to make it easier for patients to complete and submit the paperwork back to the office. We are finalizing our DME processes for telemedicine as well for a limited number of products that physicians may order which can be shipped to the patient homes with fitting supported by our techs and online resources. Roll out was gradual and deliberate as the rules for Telemedicine kept changing by the day

Both our therapy locations remain open and are seeing patients for prehab to handle delayed surgeries, post-op care and any other chronic or acute conditions requiring treatment. Patient selection criteria was developed classifying people into risk categories and those with high risk were advised to limit visits to the clinic or were offered telemedicine-only visits. Patients who were advanced in their rehab had their frequency of visits reduced. The focus was on those that were immediate post op, such as situations in which the patient’s condition may worsen if adequate therapy was not received. Social distancing was practiced by creating an adequate distance between the beds and treating patients on alternate beds only.

Like so many others, navigating these last few weeks and anticipating those to come has meant assessing clinic and department volumes and adjusting staffing needs to ensure quality service while also monitoring productivity. We have had minimal layoffs at this point.

Our physicians deferred their paychecks for two months while salaried employee pay was cut by 20 percent and hourly employees were reduced to 32 hours per week. We continue to consolidate clinics and adjust schedule templates to maximize the efficiency and productivity of our staff and physicians while considering the safety precautions necessary.

Our physicians continue to work through the application process for an SBA loan (as the rules continue to change). We have also explored multiple means of reducing cash outflow including applying for deferment of rent payments and applying for a 25 percent premium reduction program offered by TMLT if physicians were working less than 30 hours per week. Additionally, department managers have been tasked with looking at reducing cash outflow, where possible. Examples include moving casting materials and DME products from clinics we have consolidated to minimize or eliminate the need for new orders.

The decisions we have been faced with and those that may be waiting on us in the coming weeks are not ones you always plan for. This crisis is unprecedented, and we don’t have any way of knowing how it will play out.  However, we continue to use data-driven management practices seasoned with empathy, compassion, and teamwork to get through each day, hoping to make it through this intact and a stronger practice than we could have ever anticipated.