The Impact of Coronavirus Disease 2019 Restrictions on an Academic Hand Surgery Practice

Purpose: The impact of the severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) has been felt worldwide. We examined the quantitative impact during the first 4 weeks of hospital system and state-mandated restrictions on an academic, urban hand surgery practice. We hypothesized that the volume of clinic encounters, office procedures, and surgical cases would decrease and that the volume of nonelective care would remain unchanged.

Methods: We retrospectively reviewed all encounters at a hand surgery practice from March 16, 2020, through April 12, 2020 and compared those to two 4-week control time periods. Weekly encounter volumes and work relative value units (RVUs) were obtained for clinic encounters, office procedures, and surgical cases. The type of ambulatory visit was also identified. Surgical cases were categorized into 4 types (fracture or dislocation, acute soft tissue or nerve injury, infection, or elective/nonurgent) for the most recent time periods. We performed t tests to compare weekly volumes and RVUs between time periods.

Results: After the implementation of mandated restrictions on elective health care, ambulatory hand surgery clinic encounters decreased 72% to 73%, clinic procedures decreased by 87% to 90%, and surgical cases decreased by 87% to 88%. The percentage of ambulatory visits performed via telemedicine increased from 0.06% to 74%. Similar impacts on RVUs were seen. 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 coronavirus restrictions on elective healthcare led to an immediate, substantial impact on hand surgery practice. There were significant decreases in the volumes of ambulatory encounters, office procedures, and surgical cases. The long-term financial impact of this change in practice is still to be determined but, based on the quantitative impacts seen, is likely to be significant.

Type of study/level of evidence: Economic/Decision Analysis IV.