The Impact Of COVID-19 Restrictions on an Academic Hand Surgery Practice

Purpose The impact of the SARS-CoV-2 (COVID-19) coronavirus has been felt worldwide, impacting all aspects of healthcare. We examined the quantitative impact during the first four weeks of hospital system and state-mandated restrictions on elective healthcare on an academic urban hand surgery practice. We hypothesized that the volume of overall ambulatory clinic encounters, office procedures, and surgical procedures and cases would dramatically decrease during this time and that the volume of non-elective care would remain unchanged. Methods We retrospectively reviewed all patient encounters in a 4-week time period from March 16, 2020 through April 12, 2020 for an academic orthopedic hand surgery practice and compared those to two control 4-week time periods: February 17, 2020 through March 15, 2020 and March 16, 2019 through April 12, 2019. Weekly encounter volumes and work relative value units (RVUs) were obtained for ambulatory clinic encounters, office procedures, and surgical procedures and cases. The type of ambulatory visit, in-person or telemedicine was also identified. Surgical cases were categorized into four types: fracture or dislocation, acute soft tissue or nerve injury, infection, or elective/non-urgent for the two most recent time periods. T-tests were performed to compare weekly volume and RVUs between time periods. Results After the implementation of mandated restrictions on elective healthcare, ambulatory hand surgery clinic encounters decreased 72-73%, clinic procedures decreased by 87-90%, and surgical cases decreased by 87-88%. The percentage of ambulatory visits performed via telemedicine increased from 0.06% to 74%. Similar impacts on RVUs were seen. All elective surgery was deferred. Surgeries for fractures and dislocations declined by 58% and those for acute soft tissue or nerve injury declined by 40%;the number of surgical procedures for infection remained unchanged. Conclusions The COVID-19 restrictions on elective healthcare led to an immediate, substantial impact on hand surgery practice. There was a significant decrease in ambulatory encounter volume, office procedures, and surgical cases. Non-elective surgical case volume also decreased by 47%. The long-term financial impact of this change in practice on providers, practices, patients and hospitals is still to be determined but based on the quantitative impacts seen, is likely to be substantial.