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American Association for Hand Surgery

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Hand Surgeons, Taking Them at Their Word: Informing Deficit Recovery Efforts with Provider Perspectives Following the COVID-19 Pandemic
Maxwell T. Yoshida, BS, Wendy Jin, BA, Joseph S. Files, BS, BA, Austin M. Meadows, BS, Zack A. Montgomery, BS, Amy Tang, PhD and Charles S Day, MD, MBA, Henry Ford Health System, Detroit, MI

Introduction:
The SARS-CoV-2 pandemic caused postponement of elective surgeries from March to May, and was projected to decrease hospital revenue by approximately 12.5%(1). Challenges regarding elective vs emergent procedures(2) put upper extremity(UE) surgeons in a unique position compared to other orthopedic providers in the financial deficit recovery process(3,4,5,6,7). We hypothesize UE surgeons who demonstrate greater verbal commitment to overcome the financial deficit are more likely to achieve case-volume targets developed for the recovery.

Methods:
An orthopaedic research committee at a multi-hospital tertiary care medical system developed a survey examining provider perspectives on strategies for deficit recovery, including expanded clinical hours and surgical opportunities. The survey was issued to the orthopedic service line(OSL), which included fifteen UE surgeons. A commitment score developed using a Likert scale from the survey divided providers into High(3), Moderate(2), Low(1) and No Commitment(0) ratings. Weekly case-volume targets were developed by evaluating individual allotted OR time, average time per case, revenue per case, patient turnover times, and the total deficit incurred during the pandemic. Surgeons' 2020 volume targets were assessed as "target or capacity met" or "target and capacity not met". Perspectives toward and utilization of telemedicine were also assessed. Fisher's exact tests for categorical variables were conducted to assess significance.

Results:
83% of UE surgeons scored moderate to high on the self-reported commitment metric. 53.3% of UE surgeons operated at either their OR target volumes(n=2) or maximum capacity dictated by OR availability(n=6), compared to 56.4% for the OSL overall. However, UE OR target volumes averaged 3.1cases higher compared to the OSL. 50% of moderately committed and 71.4% of highly committed UE surgeons met OR targets or capacity(Fig. 1). 86.7% of UE surgeons continued scheduled video visits through Dec 2020, including 8/9 who expressed increased likelihood to use telemedicine post shutdown.

Conclusion:
A majority of UE surgeons verbalized moderate to high commitment to recovery efforts. A trend correlated higher self-reported commitment scores with achieving OR case-volume targets. UE surgeons also followed through on commitments to increase telemedicine utilization. These findings, taken together, support the use of provider survey data to inform departmental planning to meet institutional goals and navigate financial crises in the future.


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