It’s an urgent question not only for the medtech community and its patients, but one described as “top of mind" for the healthcare industry at large: How will surgical procedures recover and evolve as the country continues to navigate the COVID-19 pandemic?
When posed to a gathering of CEOs from some of the world’s largest devicemakers Tuesday, the consensus answer was that procedure volumes have made a comeback faster than expected and are approaching last year’s numbers—but long-term economic fallout and changing attitudes could also bring about a “new normal” in how care is delivered.
After sharp drop-offs as the nation locked down and began social distancing, the rate of surgical procedures began to turn around in May and June, nearing 80% of pre-COVID-19 levels, Monish Rajpal, managing director at L.E.K. Consulting, said while moderating a panel at AdvaMed's virtual conference.
Those numbers varied by medical specialty and hospital size, and of course by geographic region, Rajpal said, and were affected by range of factors including patients’ fear or reluctance to visit hospitals and clinics; unemployment rates; the prevalence of changed or dropped insurance coverage; and delays in referrals or diagnostic exams that would previously funnel patients toward certain procedures.
However, about a third of current volumes are patients who postponed their care during the initial stages of the pandemic, while hospitals and health systems have largely reduced their capacity by about 20% overall.
That’s in part because of new protocols brought on by COVID-19, including extra time allowed for surgeons and nurses to don additional personal protective equipment (PPE), said William Hawkins, former chairman and CEO of Medtronic, who now chairs the board of Duke University Health System.
“With the added complexity of PPE and everything else, it's adding about 10 minutes per procedure,” Hawkins said. “So, we have lost some efficiency … and 10 minutes is actually not insignificant for us.”
But still, patients are returning—resulting in a backlog from this year of about 7,000 cases, which Hawkins expects Duke to clear by the end of October—plus some growth on top of that.
“Honestly, I would not have expected things to have rebounded as quickly as they have, but we are about 102% of the prior year’s volume,” he said.
BD CEO and President Tom Polen said the recovery in acute areas such as peripheral vascular interventions and hernia surgeries has been more robust compared to those driven by screening processes such as biopsies or mammograms.
“And beyond procedural volumes, there’s general patient visits,” Polen said. “We look at just testing volumes—non-COVID testing volumes—as a good surrogate.”
“If you look at the types of tests that are run in routine physicals," he added, "they drive a lot of the blood testing that you may see reported out of reference labs. For routine patient visits, we saw about 75% of normal in June, and we saw that go to about 80% in July. I think that matches.”
Meanwhile, orthopedic and spinal procedures are currently seeing a “V-shape recovery,” according to Stryker Chairman and CEO Kevin Lobo.
“Everything completely stopped in the month of April,” said Lobo, who also serves as chair of AdvaMed’s board of directors. “May was better than April, and June was better than May. And that's continued into August.”
Stryker is seeing more than 80% of its procedural volume return in those areas, though the business has begun to move out of hospitals and toward free-standing, ambulatory surgery centers, where patients now seem to feel more comfortable.
“A new dynamic through the pandemic is that patients are quite happy to go home on the same day, and that's not something that patients were previously as excited about—but they don't want to be in the hospital,” Lobo said.
The wariness surrounding the coronavirus also caused surprising slowdowns in stroke and trauma care, he said, as people were afraid to go to the emergency room. But when it comes to elective surgeries and necessary orthopedic treatments, the hurried pivot toward surgical centers has only accelerated plans long in the making.
“We were already gearing up for this, but I think the medtech companies that have the hospital OR as their center of gravity have to adjust and change their approach, and really have a different strategy for the surgery centers, which we're in the process of deploying right now,” Lobo said. “It's a big change for us.”
Whatever the new normal becomes, it may not resemble how business was conducted in 2019, said Nacho Abia, chief operating officer of Olympus and president and CEO of its U.S. division.
“The only thing I know definitely is that there was a world before COVID-19 and there's going to be a world after COVID-19,” Abia said. “I think there’s going to be a significant difference not only in medicine and the way medicine is provided, but in general.”
A large part of that will come from the adoption of telemedicine, virtual consults and in-home patient care, at least for follow-ups after a procedure, he said.
Other areas, such as colonoscopies and colon cancer screening—where Olympus maintains a large presence and has seen its numbers drop significantly, while eyeing a return to form by later this year or next spring—may have their recoveries delayed until a vaccine is available.
“The only message I have for everybody is that this is the time to be flexible, to be agile more than ever and to reinvent ourselves as many times as we need to do it right,” Abia said. “I think we will be creating a new normal as we get to it.”