MSK Disorders Have Largely Gone Untreated During the Pandemic

untreated back injury COVID pandemic

What Happens Now?

During the ongoing COVID-19 pandemic, usually busy operating rooms across the country have often stood empty as hospitals paused elective surgeries to focus resources on treating patients affected by the virus and patients delayed care for fear of exposure. Overall hospital visits hit a record low in April, dropping 33 to 62%. A huge drop in treatment for musculoskeletal (MSK) disorders played a major role in declining volumes and hospital revenues, with hip replacement surgeries down 79%, knee replacements down a stunning 99% and spinal fusions down 81% during a two-week period in March and April 2020 compared to the same period in 2019.

But, of course, these declining volumes don’t mean that the need for MSK care lessened. While utilization rates have been significantly lower for these services during the peak, as states reopen and elective surgeries are rescheduled, a tidal wave of demand for care that has been delayed could swamp the system. At the outset, it may be difficult for patients to schedule surgery in a timely manner as demand surges while providers limit the number of patients they see—further delaying much needed treatment. MSK patients who put off care and now face an additional delay in accessing care may require more complex and costly treatment because their condition has worsened. 

Beyond the issues surrounding delayed MSK care, stay at home orders have left most Americans seeking a cure for severe cabin fever. After months of limited activity, more people are getting outdoors to run, walk, and bike, or are starting new home workout routines to help them get back in shape and avoid the “quarantine 15” weight gain. Unfortunately, this sudden increase in activity is likely to further swell the numbers of those with MSK problems, from back and knee pain to the exacerbation of previous disorders such as herniated discs and arthritis. 

An innovative approach to getting people the MSK recovery care they need now

While additional care delays may be difficult for patients, they provide employers and payers with an opportunity to put in place an early intervention system that provides ready access to care to mitigate the severity of MSK disorders without the need to risk COVID-19 exposure in a bricks and mortar healthcare facility.  

RecoveryOne can serve as that early intervention system, delivering digital PT and coaching to guide a structure program that helps people manage and reduce the pain and loss of function caused by MSK disorders. Not only does this recovery care have the potential to decrease pain, it can also reduce the use of opioids, lowering the risk of overuse of these highly addictive medications. Our comprehensive virtual recovery program is also a safe alternative for people who remain hesitant to seek care at a healthcare facility or undergo surgery, especially those who are older or have underlying conditions that mean they are at greater risk from COVID-19.

Personalized Musculoskeletal Recovery phone app

Our digital MSK recovery solution also has the potential to help employees and plan members avoid surgery in many cases. In fact, many MSK specialists recommend PT as the first line treatment for a wide range of musculoskeletal problems. One study published in the Annals of Internal Medicine found that for people diagnosed with lumbar spinal stenosis, those who underwent six weeks of PT achieved the same improvement in physical function as those who underwent surgery without experiencing the complications of infection, delayed wound healing and repeat surgery.  Our data, based on millions of digital sessions, shows that this model can improve function for both acute and chronic low back pain by over 90% while significantly reducing pain to an average of 1.5 on a scale of 1 to 10. It can also reduce surgical procedures and lower costs for health plans and employers while keeping users happy and engaged.

Of course, surgery is sometimes the most appropriate course of treatment. When employees and plan members need to undergo a procedure for their MSK condition, RecoveryOne’s digital PT and coaching solution provides a comprehensive prehab program from the safety and convenience of home. We provide a structured exercise program that follows rigorous clinical pathways to help them get stronger and healthier so they can better tolerate surgery. RecoveryOne also provides the post-surgical rehab support these employees and plan members need to recover more quickly, feel better sooner, and get back out there. 

In the News – Why Managed Care Organizations Must Consider the Effect of COVID-19 on MSK Care

This article originally appeared in Managed Healthcare Executive. To read the entire article, please go to the original article page.

All across the country, and in fact globally, musculoskeletal (MSK) care has become difficult if not impossible for most patients to access because of the COVID-19 pandemic. These injuries may be piling up on couches and porches across America as many go without help. Many hospital-based physical therapy (PT) centers and private PT practices have paused providing in-person assessments and care to avoid close personal contact that increases the risk of spreading the virus.

Although access to MSK care has contracted, the urgent need for these services has not. MSK disorders affect half of all American adults, with more than 126 million Americans over the age of 18 reporting being diagnosed with one of these conditions. These disorders have a significant impact on the health and quality of life of those affected, with approximately 18 million reporting an MSK disorder prevents them from performing daily activities, including walking unaided, bathing, and using the bathroom.

Beyond the pain and limitations experienced by individuals, MSK disorders also exact a high economic cost, affecting employers in every industry as well as insurers:
• MSK disorders account for $213 billion in direct and indirect costs, according to a CDC survey
• Back and neck pain alone are responsible for 290.8 million lost workdays, according to one study.
• Employers spend $20 billion a year on MSK disorders, accounting for 17% of their total healthcare budgets.
• Direct medical expenses cost payers a total of $130 billion.

These numbers are projected to continue to grow substantially as the number of older Americans increases.

Read more of the original article on Managed Healthcare Executive.

Health Plans and Employers ‘Muscle Up’: Virtual Care Delivers Safe, Effective MSK Recovery

During the COVID-19 global health emergency, people are avoiding hospitals and other health care facilities because they’re concerned about being exposed to the virus. In fact, a recent Sage Growth/Black Book research survey found that 33% of respondents feel unsafe going to their doctor’s office and 41% feel unsafe going to a hospital. While that reticence may help hospitals avoid being overwhelmed, it’s absolutely not helping the people who’ve chosen to delay getting the care they need. How big is the issue? A recent Morning Consult-American College of Emergency Physicians poll found that nearly a third (29%) of survey respondents said they had avoided or delayed seeking medical care due to concerns about contracting the virus.

Half of American adults (127 million people) are estimated to be living with musculoskeletal (MSK) disorders. For them, the impact of delaying or going without care is significant and includes:

  • Living with ongoing pain, which in turn has the potential to increase use of and reliance on opioid medications
  • An increase in dysfunction that results in an inability to perform daily activities or work
  • A progression of the disease’s severity that may increase the likelihood of surgery or permanent disability

Before the pandemic struck, people with MSK disorders could access care safely and fairly easily. But even pre-pandemic, there was a significant unmet need for this care. Insurers typically pay for a limited number of physical therapy visits. If the person’s condition hasn’t improved, he or she needs to get approval for another limited number of visits, which can be time-consuming and frustrating. In addition, completing even this limited course of therapy can be challenging for many people who need to take time off work or secure childcare and travel to the location where their therapy is provided.

“I think it’s fair to say that the advent of telehealth has been just completely accelerated… there’s absolutely no going back.”
– Seema Verma, CMS administrator

A better way, now and moving forward

For the foreseeable future as the pandemic continues without an approved vaccine, people need a safe new way to access MSK care. And even if the pandemic can be contained, not everyone will feel comfortable returning to health care facilities, especially those who are more vulnerable and at risk from the virus, like people over 65 and those with underlying chronic health conditions. There’s also likely to be a backlog of people in need of care, which may make it a lot more difficult to get an appointment with an orthopedist or physical therapist, further delaying access to care.

The solution, for both the current situation and the future, is making quality MSK care available on patients’ terms—safely, outside a health care facility, when and where it’s most convenient. Telehealth can provide that solution in both the short and long term.

CMS Administrator Seema Verma

CMS Administrator Seema Verma (courtesy of Wikimedia Commons)

The time is right for telehealth to expand its reach. Medicare has relaxed its guidelines on the type of telehealth services it covers and enhanced its coverage through the summer, and many commercial insurers are following suit. And it’s likely these coverage enhancements will continue in some form indefinitely. Even CMS administrator Seema Verma has gone on the record saying, “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

Along with better coverage and reimbursement for telehealth, patients are also embracing virtual access to care. At the end of March, the Wall Street Journal reported a marked increase in telehealth visits by Medicare patients, from 100,000 per week to 300,000 per week. A Sage Growth/Black Book research survey also highlights patients’ growing desire for and acceptance of telehealth services. Of survey respondents, 48% are seeking more digital health solutions to manage their health and well-being and more than two-thirds (69%) of respondents want their provider to offer more telehealth visits as an alternative to office visits even after the pandemic ends.

But not all telehealth or digital solutions will deliver what people with MSK disorders truly need. Beyond ease of access from the safety of home, people need to receive care on an episode basis, not on a limited visit basis, so that they can receive care as long as it takes to recover. They need clinically validated assessments and recovery pathways, and access to personalized exercise plans overseen by physical therapists and coaches.

The good news is that RecoveryOne has already created this new model of care and is delivering on-demand, clinically validated MSK recovery care to people across the country. A growing number of insurers and employers are including this new resource in the benefits they offer, opening access for hundreds of thousands of those who will need this care long after the pandemic ends. After delivering millions of sessions, we’ve proven that this model can improve outcomes by up to 54%, reduce the need for surgery, lower costs for patients, payers, and employers—while earning a patient satisfaction rate of over 88%.

The essential role of health plans and employers in the safe delivery of care

But even as more health plans and employers make coverage for telehealth an integral part of their benefit offerings, there’s more work to be done to keep people safer during and after the height of the pandemic. They need to move from passively offering new virtual MSK solutions to taking proactive steps to identify and engage those who most need this care.

That means mining their own databases to identify those who’ve been pre-certified for MSK surgery, who have an existing MSK disorder that has gone untreated, and those prescribed opioid medications for pain related to MSK disorders. Plan administrators can connect these populations with virtual MSK services, helping them avoid unnecessary visits to healthcare facilities where they risk exposure to COVID-19.

Health plans and self-insured employers cannot afford to be passive, communicating the availability of telehealth coverage on a one and done basis. We all need to be proactive partners in the effort to keep people safer in this new world by encouraging the appropriate use of remote care.