Frank Raneri, Senior Vice President, Paradigm Specialty Networks
The COVID-19 pandemic delayed a large number of workers’ compensation-related orthopedic surgeries, many of which were scheduled to be performed in ambulatory surgery centers (ASCs). Since ASCs resumed operations in early May, taking a closer look at their response to the pandemic can help illuminate some of the challenges and opportunities currently facing the workers’ compensation surgical space. With the pandemic continuing to be an ongoing concern in the United States, ASCs unique qualities provide many potential benefits to patients and payers alike, which we will explore in this two-part series.
On March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, as well as non-essential medical, surgical, and dental procedures, were to be delayed during the COVID-19 outbreak. Outpatient surgery centers and ASCs responded quickly—and with good reason. The medical community anticipated that the exponential rate of infection could put a strain on hospital systems, risking shortages in the availability of beds, personal protective equipment (PPE), and lifesaving ventilators for the critically ill.
By April 18, hospitalizations related to COVID-19 peaked at 10 persons per 100,000 nationwide, and 33.4 persons per 100,000 over the age of 65.1 The surge was significant at the time, but fortunately manageable.
Preparations in April for needed ASC services due to the surge went unfulfilled. Almost concurrent with the peak in COVID-19 hospitalizations that month, CMS issued its “Opening Up America Again” memo to guide states through the proposed gating criteria to reopen the economy and in turn, resume non-essential surgical activity.2 By Memorial Day, all states had a policy in place that included the resumption of elective surgeries.
How ASC closures affected workers’ compensation surgical cases
At least two-thirds of all workers’ compensation surgeries are performed on the knee and shoulder, many of which are essential, not elective, to the injured worker’s recovery. Despite this, typical workers’ compensation knee and shoulder repairs are rarely emergent and the vast majority of them were postponed during the pandemic response. Experts estimate that overall, 82% of all worldwide orthopedic surgeries were canceled or postponed during the 12-week height of the pandemic. This equated to approximately 6.3 million procedures.3
To exhibit a workers’ compensation analog, Paradigm Specialty Networks, the segment of our business that manages orthopedic and spinal care for our customers, reported a peak to trough decline of 64% in surgical dates of service between January 1 and April 15, then a subsequent 182% rebound from April 16 to June 15—a nearly symmetrical “V-shaped” recovery and confirmation of the expected backlog in surgical demand.
By all accounts, the outpatient and ambulatory surgery market avoided the worst-case scenario at the time by both averting an overwhelmed health system and catastrophic economic losses. Paradigm Specialty Networks has communicated to our customers and the industry at large that ASCs are back operating at 75% capacity or higher as of July 1. This has confirmed what most analysts expected, as a backlog in surgical procedure demand is now being met.
ASCs continue to assist workers’ compensation surgical cases during the pandemic
Despite surviving the peak in hospitalizations back in April, positive COVID-19 case counts have only continued to climb — and we do not know what the future holds. Pockets of outbreaks in Florida, Arizona, and Texas have caused some major hospital systems to once again postpone elective surgeries, but those edicts have not yet affected the ASC communities. Overall, hospitalizations are still far lower nationally. As of June 27, the weekly hospitalization rate was down 75% from the peak at only 2.5 persons per 100,000, and was 85% lower for those over 65 at roughly 5.0 persons per 100,000.1
What does this continuing threat of COVID-19 infection mean for injured workers who still require surgical care? Now that ASCs have reopened and are operating at or near capacity, they’re positioned to play a critical role in achieving positive outcomes for workers’ compensation cases throughout this crisis.
Due to the way they’re structured and their dedicated focus, surgery centers can function on a highly cost-effective basis while significantly reducing many hospital-associated risks. In comparison to hospitals, ASCs offer unique advantages that protect injured workers from COVID-19 infection, including a cleaner environment, empty or isolated waiting rooms, and enforced distancing protocols during the business day. As is presently the standard, ASCs also perform mandatory COVID-19 preoperative testing for all patients.
In an upcoming second part of this discussion, we’ll take a more in-depth look at the promising results that ASCs have achieved—both in terms of outcomes, cost savings, and how this can benefit both businesses and injured workers.
About Frank Raneri
Frank Raneri currently serves as Senior Vice President of Network and Client Services for Paradigm Specialty Networks. He oversees the development and growth of Paradigm’s complementary network solutions and the provision of client outcomes therein. Through selective participation, deliberate contracting, active provider development and scoring, Frank’s role is to best position Paradigm’s clients in managing their high acuity programs to improve outcomes and reduce costs.
Frank joined Paradigm in 2019 with more than 18 years of industry experience, particularly focused on the development of workers’ compensation specialty networks. Frank held operational and client-facing leadership roles before joining Paradigm in ancillary services, field case management, and MSP compliance. Frank can be reached at [email protected]
For almost 30 years, Paradigm has been the industry leader in solving catastrophic and complex health care challenges and improving lives. With the most connected and experienced team in health care, we define and deliver outcomes that exceed financial and health expectations for our clients, as well as for individuals and their families.
Paradigm delivers its solutions through three divisions: Catastrophic Care Management, Complex Care Solutions, and Specialty Networks. The Paradigm divisions are built on expertise from six best-in-class businesses: Paradigm Outcomes, The ALARIS Group, Encore Unlimited, Restore Rehabilitation, ForeSight Medical, and Adva-Net. Founded in 1991, Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit https://www.paradigmcorp.com/.
Paradigm Specialty Networks offers innovative, data-driven network solutions for the most challenging, expensive, and unmanaged segments in workers’ compensation: orthopedic and spine, pain management, addiction recovery, post-acute care, behavioral health, and surgical implants.
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This is not a paid placement.