Fundamental Changes to Orthopedic Surgery Booking

COVID-19 has significantly disrupted the orthopedic industry. As seen in Figure 1, DocSpera observed the nearly complete halt of elective surgeries in mid-March across the United States as a result of the stay-at-home orders and mandatory surgical cancellations.

Once elective surgeries were permitted to resume by state governments, surgeons were forced to grapple with a huge backlog of patients who had their surgeries cancelled as well as the regular flow of new patients who also were in need of surgery. When combined with the fact that many practices had to lay off large portions of their administrative staff, the problem became practically unmanageable.

Since that time, DocSpera has observed a fundamental change in the statistics of how orthopedic surgeries are being booked, which has significant implications for not only surgeons and their patients but also medical device manufacturers and healthcare systems at large. 

Most notably is the reduction in lead time across the United States. Lead time is defined as the difference between the surgery booking date and the actual surgical date. To control for the anomalous nature of the first two months of the pandemic in which the state-mandated surgical cancellations occurred, March and April of this year were taken out of the analyses. Additionally, to ensure sample sizes were the same for comparisons, an equal number of months were selected for pre and post COVID-19 groups: 11/2019 to 2/2020 for Pre-COVID and 5/2020 to 8/2020 for Post-COVID. Medians were used as averages instead of means because the data were highly positively skewed. As seen below in Figure 2, a majority of the cases were concentrated towards smaller lead times.

In the months leading up to the outbreak of COVID-19, orthopedic practices using DocSpera were reporting a national median lead time of 20 days. In the most recent few months, lead time has decreased to 13 days. Figure 3 below displays the average lead times broken down by state for a more granular picture of the changes across the country.

On top of this, cancellation rates seemed to have increased about 2% as previously shown in Figure 1. These differences cannot be explained by insurance or other administrative related issues as these would have existed before the pandemic. Additionally, the biased first months of mandatory cancellation were removed so this data indicates that the industry is truly seeing a “new normal” where surgical lead times are shorter and cancellation rates are higher than before the pandemic began. The most likely explanation for this is a combination of patients’ fear to undergo surgeries during this crisis and schedulers uncertainty of the future, leading to orthopedic practices only booking cases about two weeks in advance. 

To address this ongoing uncertainty and increased administrative burden on orthopedic practices, DocSpera has built the Intelligent Scheduler, a tool that allows surgeons and schedulers to effectively re-prioritize their patients at scale. Patients are sent intake surveys to collect pertinent information such as their availability, pain and narcotic usage, functionality, fall risk, comorbidities, and COVID-19 exposure. This data is then outputted in an interactive dashboard, where surgeons can pick from a selection of automated prioritization algorithms and sort their patients accordingly. This information can then be used while rebooking patients to ensure that those who need surgery the most are scheduled the soonest.