Surgeons Working Extra 32 Minutes/Patient!

By looking at video, phone, and text messages, researchers from Columbia University Medical Center have determined that surgeons’ postoperative work is being greatly underestimated. Their work, “Quantifying the Surgeon’s Increased Burden of Postoperative Work for Modern Arthroplasty Surgery,” appears in the July 1, 2021 edition of The Journal of Arthroplasty.

Lead author Dr. Roshan Shah, an associate professor of surgery at Columbia University Vagelos College of Physicians and Surgeons, told OTW, “Arthroplasty continues to evolve, and some payers interpret new efficiencies and trends away from inpatient care as requiring less actual work, therefore triggering efforts to pay surgeons less. In reality, work never decreases. It just changes. This paper looks at the ways it is changing, especially with modern communication streams.”

The team looked at 47 consecutive primary hip, knee, and partial knee arthroplasties done at one facility 30 days before March 15, 2020. They quantified the duration of video telehealth, telephone logs, and text messages over 90 days to calculate the postoperative work performed.

“An average of 9.4 touchpoints (2-14) by the surgeons occurred during the global period for this cohort, totaling 219 minutes (51-247 minutes),” wrote the authors. “This included an average of 21 minutes of day-0 calls to family, 117 minutes for video visits, 52 minutes for phone calls, and 29 minutes for text messaging and wound photos.”

“All electronic touchpoints were carefully documented during the pandemic due to policy changes that allowed telephone and video visits to be billed,” Dr. Shah explained to OTW. “Previously, these calls were made but not documented as frequently. So, by having a better record, we found that surgeons are working on average 32 minutes more per patient in the post-operative period than we are currently attributed by the CPT codes, even when performing same day joint replacement.”

“Downward pressure on payments results in tightening access to care. We have ample evidence of this with the lowest payers throughout all states. Although it’s indirect, papers like this one help support access to care for patients.”