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While we always look forward to meeting many of you in person during the North American Spine Society’s (NASS) Annual Meeting, COVID-19 is pushing the conference to a virtual format this year. But Eeric Truumees, M.D., First Vice President of NASS’ Board of Directors, is optimistic that the online event will allow attendees to benefit from broader input in smaller doses.
Eeric Truumees, M.D., First Vice President of NASS’ Board of Directors
As an orthopedic spine surgeon, Dr. Truumees was attracted by the multidisciplinary nature of NASS and joined in 1999, serving on a variety of committees. He’s also the CEO of the Seton Brain and Spine Institute and a professor of orthopedic surgery at the University of Texas, Dell Medical School in Austin.
In addition to touching on NASS 2020, Dr. Truumees spoke with us about the impacts he’s seen from COVID-19 in his practice, as well as from colleagues, and other trends accelerated by the pandemic that will move the industry forward.
What has been your experience as a spine surgeon and hospital executive in the last six months?
Dr. Truumees: It’s been a rollercoaster. We’ve had temporary impacts on our elective surgeries for various reasons in the past, but nothing this broad or long-lasting.
There have been phases. Back in March, we didn’t know what was going to happen. Then, during April and May, everyone was sheltering at home; we were only doing urgent procedures, and even those were down because there was less driving and vehicular trauma.
At least here in Texas, it’s been a rollercoaster of decreasing cases and then returning to elective surgery and cases go back up, and back and forth. From a planning and budgetary standpoint, it’s been next to impossible, but things seem to be gradually getting better.
We were expecting a lot of catch-up surgery. There is some of that, but not as much as I expected. On the non-elective side, we’re seeing fewer patients but with more severe problems like tumors or spinal infections that didn’t get early management. They end up having higher surgery rates and bigger operations than they may have had otherwise due to lack of early management.
I tried to make predictions on the recovery to my colleagues a couple of months ago. Some things surprised me. We thought that we would begin elective surgeries with young patients with simple operations that don’t require ICU stays and extended hospitalizations, but a lot of those patients are concerned about job loss and insurance issues. They are only now starting to come back at previous rates of surgery, and there hasn’t been nearly as much catch-up with those patients. On the other hand, some of the older patients, retirees and the Medicare population, have been more than happy to get their procedures done because their other activities have all been postponed.
What specific lessons have you learned?
Dr. Truumees: The pandemic has highlighted just how closely surgeons are tied to the rest of the healthcare system. For example, I know colleagues who are highly specialized spine surgeons in New York who were walking around the ICUs flipping patients to proning positions. On a more practical level, the pandemic has brought to light how essential access to personal protective equipment is to our work, both surgical procedures and non-operative spine care.
The restrictions on elective surgery, and the impact on the system at large and how we treat people has also been interesting.
I worry about how Texas, as one of the states with the highest rates of uninsured patients, is going to look relative to the job losses. As people start getting their jobs and insurance back, their ability to seek out spine care will improve, but a lot of them are very reluctant due to employment concerns.
The way we’re tied into all of these external forces has become increasingly clear.
How will COVID-19 impact the future delivery of spine care?
Dr. Truumees: COVID-19 will affect us in a number of ways, but I think a lot of it is going to precipitate trends that were there already.
Telemedicine has gotten a huge boost, both due to the pandemic and the response from insurers and CMS in regard to how they cover and pay for it. The increased accessibility of distanced consultations may very well lead to more subspecialization. You may see more cervical spine specialists, lumbar spine specialists, apart from the normal areas that deal with deformity and tumors.
The pandemic will accelerate minimally invasive surgery and endoscopic approaches because patients want to stay out of hospitals. They want to have procedures done in an outpatient setting or ASC or specialty hospital. That’s going to drive a lot of advancement around enabling technologies like navigation and robotics. The more we can do these procedures through smaller incisions and keep people away from long inpatient stays, the better off they’re going to be.
However, moving toward outpatient and ambulatory surgery centers does pose some challenges. It will be up to the owner of each center to invest in these new technologies, like robots and nav systems. The hold on elective surgeries and other financial hits may delay these investments. But, on the payment side, the Centers for Medicare & Medicaid Services has clearly signaled that they’re getting rid of the inpatient-only list. As that moves forward over the next few years, I think a lot of the financial challenges will continue to decline and it’ll get easier to offer a wider swath of patients that kind of care. It’s really going to come down to which patients are healthy enough for care in that setting versus in a hospital.
What important topics will be discussed at NASS 2020?
Dr. Truumees: The annual meeting will discuss both evolving and revolutionary approaches in spine care, as well as the best ways to achieve good sagittal balance of the spine patient and what’s enough surgery versus what’s too much. Another big part of this, though, is how we learn and how we share information. The virtual meeting for me means that I can seek input from a much broader group of people, but in smaller doses and more frequently.
There will be a focus on the important clinical topics and then more touchpoints over the course of the year to back up our knowledge base and make it practical for people to implement these technologies in their own practices.
On a final note, as a CEO, what leadership advice can you share, especially in light of the pandemic?
Dr. Truumees: If you’re on the hospital side, projecting personnel needs is important because a lot of places have given up or moved some of their bandwidth, even furloughed employees, and are now starting to bring them back. It’s not always a smooth process.
On the industry side, all of us have relied on in-person meetings like NASS to get our hands on the latest technologies and see what they look like and how they feel, and then followed up with in-person surgeon visits to a company’s training center or anatomy lab. Those processes will resume gradually, but I also think there’s also going to be a reinvention of how much of that is done in person and there are a number of great new virtual systems coming out. How we share these ideas and educate people on how to use a given technology will change significantly over the next two to three years, even as we move past COVID.
Do you have any last comments?
Dr. Truumees: One area in which the industry has been a good partner is data collection, which will continue to show the value of the procedures we’re doing and the implants we’re using. There are a number of registries, such as AAOS and NASS. Supporting those efforts will help all of us in the end as we work to show who will benefit the most from procedures, keep our eye to decrease risks and improve quality. Those are arguments we’re going to need to make to payors and the population at large. COVID-19 will only increase fear and, therefore, the need to demonstrate the worth of these procedures and why we should spend money on them.
Carolyn LaWell is ORTHOWORLD’s Chief Content Officer.
While we always look forward to meeting many of you in person during the North American Spine Society’s (NASS) Annual Meeting, COVID-19 is pushing the conference to a virtual format this year. But Eeric Truumees, M.D., First Vice President of NASS’ Board of Directors, is optimistic that the online event will allow attendees to benefit from...
While we always look forward to meeting many of you in person during the North American Spine Society’s (NASS) Annual Meeting, COVID-19 is pushing the conference to a virtual format this year. But Eeric Truumees, M.D., First Vice President of NASS’ Board of Directors, is optimistic that the online event will allow attendees to benefit from broader input in smaller doses.
Eeric Truumees, M.D., First Vice President of NASS’ Board of Directors
As an orthopedic spine surgeon, Dr. Truumees was attracted by the multidisciplinary nature of NASS and joined in 1999, serving on a variety of committees. He’s also the CEO of the Seton Brain and Spine Institute and a professor of orthopedic surgery at the University of Texas, Dell Medical School in Austin.
In addition to touching on NASS 2020, Dr. Truumees spoke with us about the impacts he’s seen from COVID-19 in his practice, as well as from colleagues, and other trends accelerated by the pandemic that will move the industry forward.
What has been your experience as a spine surgeon and hospital executive in the last six months?
Dr. Truumees: It’s been a rollercoaster. We’ve had temporary impacts on our elective surgeries for various reasons in the past, but nothing this broad or long-lasting.
There have been phases. Back in March, we didn’t know what was going to happen. Then, during April and May, everyone was sheltering at home; we were only doing urgent procedures, and even those were down because there was less driving and vehicular trauma.
At least here in Texas, it’s been a rollercoaster of decreasing cases and then returning to elective surgery and cases go back up, and back and forth. From a planning and budgetary standpoint, it’s been next to impossible, but things seem to be gradually getting better.
We were expecting a lot of catch-up surgery. There is some of that, but not as much as I expected. On the non-elective side, we’re seeing fewer patients but with more severe problems like tumors or spinal infections that didn’t get early management. They end up having higher surgery rates and bigger operations than they may have had otherwise due to lack of early management.
I tried to make predictions on the recovery to my colleagues a couple of months ago. Some things surprised me. We thought that we would begin elective surgeries with young patients with simple operations that don’t require ICU stays and extended hospitalizations, but a lot of those patients are concerned about job loss and insurance issues. They are only now starting to come back at previous rates of surgery, and there hasn’t been nearly as much catch-up with those patients. On the other hand, some of the older patients, retirees and the Medicare population, have been more than happy to get their procedures done because their other activities have all been postponed.
What specific lessons have you learned?
Dr. Truumees: The pandemic has highlighted just how closely surgeons are tied to the rest of the healthcare system. For example, I know colleagues who are highly specialized spine surgeons in New York who were walking around the ICUs flipping patients to proning positions. On a more practical level, the pandemic has brought to light how essential access to personal protective equipment is to our work, both surgical procedures and non-operative spine care.
The restrictions on elective surgery, and the impact on the system at large and how we treat people has also been interesting.
I worry about how Texas, as one of the states with the highest rates of uninsured patients, is going to look relative to the job losses. As people start getting their jobs and insurance back, their ability to seek out spine care will improve, but a lot of them are very reluctant due to employment concerns.
The way we’re tied into all of these external forces has become increasingly clear.
How will COVID-19 impact the future delivery of spine care?
Dr. Truumees: COVID-19 will affect us in a number of ways, but I think a lot of it is going to precipitate trends that were there already.
Telemedicine has gotten a huge boost, both due to the pandemic and the response from insurers and CMS in regard to how they cover and pay for it. The increased accessibility of distanced consultations may very well lead to more subspecialization. You may see more cervical spine specialists, lumbar spine specialists, apart from the normal areas that deal with deformity and tumors.
The pandemic will accelerate minimally invasive surgery and endoscopic approaches because patients want to stay out of hospitals. They want to have procedures done in an outpatient setting or ASC or specialty hospital. That’s going to drive a lot of advancement around enabling technologies like navigation and robotics. The more we can do these procedures through smaller incisions and keep people away from long inpatient stays, the better off they’re going to be.
However, moving toward outpatient and ambulatory surgery centers does pose some challenges. It will be up to the owner of each center to invest in these new technologies, like robots and nav systems. The hold on elective surgeries and other financial hits may delay these investments. But, on the payment side, the Centers for Medicare & Medicaid Services has clearly signaled that they’re getting rid of the inpatient-only list. As that moves forward over the next few years, I think a lot of the financial challenges will continue to decline and it’ll get easier to offer a wider swath of patients that kind of care. It’s really going to come down to which patients are healthy enough for care in that setting versus in a hospital.
What important topics will be discussed at NASS 2020?
Dr. Truumees: The annual meeting will discuss both evolving and revolutionary approaches in spine care, as well as the best ways to achieve good sagittal balance of the spine patient and what’s enough surgery versus what’s too much. Another big part of this, though, is how we learn and how we share information. The virtual meeting for me means that I can seek input from a much broader group of people, but in smaller doses and more frequently.
There will be a focus on the important clinical topics and then more touchpoints over the course of the year to back up our knowledge base and make it practical for people to implement these technologies in their own practices.
On a final note, as a CEO, what leadership advice can you share, especially in light of the pandemic?
Dr. Truumees: If you’re on the hospital side, projecting personnel needs is important because a lot of places have given up or moved some of their bandwidth, even furloughed employees, and are now starting to bring them back. It’s not always a smooth process.
On the industry side, all of us have relied on in-person meetings like NASS to get our hands on the latest technologies and see what they look like and how they feel, and then followed up with in-person surgeon visits to a company’s training center or anatomy lab. Those processes will resume gradually, but I also think there’s also going to be a reinvention of how much of that is done in person and there are a number of great new virtual systems coming out. How we share these ideas and educate people on how to use a given technology will change significantly over the next two to three years, even as we move past COVID.
Do you have any last comments?
Dr. Truumees: One area in which the industry has been a good partner is data collection, which will continue to show the value of the procedures we’re doing and the implants we’re using. There are a number of registries, such as AAOS and NASS. Supporting those efforts will help all of us in the end as we work to show who will benefit the most from procedures, keep our eye to decrease risks and improve quality. Those are arguments we’re going to need to make to payors and the population at large. COVID-19 will only increase fear and, therefore, the need to demonstrate the worth of these procedures and why we should spend money on them.
Carolyn LaWell is ORTHOWORLD’s Chief Content Officer.
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Julie Vetalice is ORTHOWORLD's Editorial Assistant. She has covered the orthopedic industry for over 20 years, having joined the company in 1999.
