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ep. 2

Hospital Systems in the COVID-19 Era

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Orthopaedic physicians and practice managers have had to make swift, disruptive changes to how they operate their practices since the start of the COVID-19 pandemic. This is especially true of hospital systems that witnessed waves of coronavirus patients, protective equipment shortages, and reduced revenues as elective procedures were postponed. 

In this episode of the Growing a Successful Orthopaedic Practice Podcast, Joseph W. Greene, M.D., a hip and knee orthopaedic surgeon working with Norton Healthcare joins Keith Landry, to discuss how hospital systems and orthopaedic surgeons are adapting to prepare for the post COVID-19 era.

Dr. Greene offers insights on how orthopaedic surgeons can adapt if elective procedures continue to be postponed due to the pandemic. 

Tune in to discover:

  • Why rural hospitals are using telemedicine to cover ER on-call staffing
  • Will orthopaedic surgeons have to specialize even more to survive?
  • The push for more surgeries to be done in ambulatory surgery centers
  • What medical residents should look for when joining their first orthopaedic practice
  • How hospitals are using telehealth visits to assess patient injuries before they go to the emergency room

About Dr. Joseph Greene

Joseph W. Greene, M.D., is a hip and knee orthopaedic surgeon specializing in revisionist procedures with North Healthcare in Louisville, KY. He has been working within the Norton Healthcare hospital system for more than 8 years. Dr. Greene undertook his medical education, internship and medical residency at the University of Louisville.

About Keith Landry

Keith Landry is Director of Public Relations at Insight Marketing Group. Keith has been a public relations consultant since 2010. He has more than 26 years of experience as a news anchor, news reporter and public affairs show host, which he uses to implement innovative public relations strategies for medical practice clients.

Sponsored by OrthoLive

Episode Transcription

Joe Greene: I think more patient encounters and more opportunity to get to know people increases your practice greatly. I would really look for a practice where you seem to be a good fit. And so, really that’s the key. I don’t really necessarily think it’s healthcare system versus private practice, but you need to find a group of people that you enjoy working with, and that seem to be of the same mentality that you have to kind of be happy on a day to day basis.

Speaker 2: Welcome to the Growing A Successful Orthopedic Practice podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians, as we break down current issues affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice.. Let’s get started.

Jennifer: Hey there. Welcome to another episode of the Growing A Successful Orthopedic Practice podcast. I’m your host Jennifer. Today, we’re going to be talking about hospital systems in the COVID-19 era. Orthopedic physicians and practice managers have had to make swift disruptive changes to how they operate their practices since the start of the pandemic. This is especially true of hospital systems, which have witnessed waves of coronavirus patients, protective equipment shortages, and reduced revenues as elective procedures have been postponed.

In today’s episode, Dr. Joseph Greene a hip and knee orthopedic surgeon, working with Norton Healthcare joins Keith Landry to discuss how hospital systems and orthopedic surgeons are adapting to prepare for the post COVID era. Dr. Greene offers insight on how orthopedic surgeons can adapt if elective procedures continue to be postponed.

Tune in to discover why rural hospitals are using telemedicine to cover ER on call staffing. We’re going to answer the question of whether orthopedic surgeons need to specialize even more to survive. We’re going to talk about the push for more surgeries to be done in an ambulatory surgery center, what medical residents should look for when joining their first orthopedic practice, and how hospitals are using telehealth to provide access for patients before they go to the emergency room.

Now, Dr. Joseph Greene is a hip and knee orthopedic surgeon who specializes in revisionist procedures with North Healthcare in Louisville, Kentucky. He’s been working with the Norton Healthcare Hospital System for more than eight years. And Dr. Greene undertook his medical education, internship, and residency at the University of Louisville.

Keith Landry, he’s our director of public relations over here at Insight Marketing Group. Keith has been a public relations consultant since 2010 and brings more than 26 years of experience as a news anchor, news reporter, and public affairs show host, which he uses to implement innovative public relations strategies for our medical practice clients. Let’s go ahead and get started. I’m going to turn it over to Keith. Hey Keith.

Keith Landry: Thank you everyone for listening into the podcast today. I’m joined by Dr. Joe Greene, a hip and knee surgeon with Norton Healthcare. Thanks for being here. Looking forward to your insights today.

Joe Greene: Well, thanks a lot for having me. It’s a pleasure being on the podcast and I’m excited to hear what we talk about.

Keith Landry: It was great having a name, Joe Greene. Your email’s Mean Joe Greene, I’m sure you hear about that quite a bit.

Joe Greene: Oh yeah. I’ve gotten it in my whole life. That’s why I adopted the email address and become a Pittsburgh Steelers fan, even though I’m based in Louisville, Kentucky.

Keith Landry: All right. You’ve been working with a hospital system for eight years now in the Louisville area as a hip and knee surgeon. That’s your specialty. What have you observed? When you came out of medical school, why did you decide to go into the hospital system instead of joining a private practice the beginning of your career?

Joe Greene: Sure. I think that’s a great question. I think the old dictum was that you went and you joined a private practice right out of residency, that you worked there and you were a junior partner for a period of time, and then you bought into the practice, or you actually accrued a lot of assets, including real estate, the practice setting, potentially surgery centers, et cetera. As I was going through my residency, which I finished in 2012, started in 2007, there was a big shift where people started to become more and more employed by actual hospital systems.

I think a lot of that had to do with the starting salaries were much higher versus joining a private practice. I think some of the private practices started to run into a little bit more of a pinch with healthcare reimbursement to where their finances were actually a little bit lower. And so, that healthcare systems were able to pay surgeons more than the private practices. I also think that some of the surgeons saw that there was a built in primary care network referral basis, which set up for some success within the healthcare systems.

Personally, I looked more at a practice setting, and then where I fit in with my specialty, which was doing primarily complex knee, and then also some hip surgeries. Really, I was looking personally for a role where I could do those surgeries and be kind of a tertiary referral center where patients were sent for a wide geographic area, but also have the capability to teach and work with the residents, if not higher level like the fellowship we currently work with. For me, it was a select two or three practices in the city of Louisville, besides the University of Louisville Department of Orthopedic Surgery. So, that’s what led me to being a hospital employee right out of my fellowship.

Keith Landry: All right. Let’s switch gears for some insights that we can only get from somebody who works inside a hospital. A lot are fascinated about life inside a hospital in 2020 in the pandemic era. In April and May, we saw just severe strains on the system, especially within hospitals. What did things look like inside your hospital in April and May? Were you stretched for resources? Was it chaotic and ER? Were there are shortages of protective equipment and things like that?

Joe Greene: Okay. That’s what we were afraid of. I’m in Louisville, Kentucky. I did my fellowship training in New York City. So I was watching very closely in New York because I still have my fellowship mentors. A lot of my colleagues are in the city or the surrounding area. And so, once we started hearing really scary reports from Europe, that’s when I really started to become worried about resources. You started hearing about doctors having to pick who’s on a ventilator and who’s not. And so, that was pretty terrifying, honestly. Then, as we saw the surge in New York City, which I thought would probably happen just with the level of mass transit, and from living there and knowing that there’s really no way to get away from other human beings in a city of that population, but we started to seeing their resources being stretched.

I thought it was very prudent that the governor of Kentucky shut down hospitals, essentially, for elective procedures, which unfortunately for a hip and knee joint surgeon, that’s most of my practice. But, I thought that was a good call, because I think we were all really scared about resources and taking care of family members, especially people in my parents’ generation, in the 70s and maybe even younger than that. In my hospital, actually that never came to fruition. Thank goodness. Really, the hospital was not stressed. We really shut down all elective procedures. The hospital, really, was at about a quarter percent of its normal capacity. Really, we would run our hospital at a very, very high occupancy rate because of the level of orthopedic surgery we do there. And so, we were at about 25% full. A lot of the nurses were put in a different task, working either in office settings or checking people for temperatures.

The emergency room was not very busy either, which was surprising.

Keith Landry: It is.

Joe Greene: I think a lot of folks were trying to avoid it. We just did not see the surge in Kentucky that other states have seen. As of right now, where you’re starting to see surges in Florida, where Tampa is going to stop elective surgeries, and some other areas in Florida and Texas have already declared that again, we just haven’t seen it so far in Kentucky in the Midwest. Hopefully, we continue to see low rates here, but you never know. And so, we have to just continue to be diligent and try to do the best thing that we can for our friends and family.

Keith Landry: It hasn’t been too bad where you are, but what do you think about this notion of months upon end and different waves of rolling back elective surgeries, for health reasons, to greater general public consideration, but how does that affect someone like you or our listeners who are specialists that have to do some surgeries to feed the family?

Speaker 1: Yeah, I think, luckily for me, within the hospital setting, I continue to take call and do call cases, which generated some revenue. I think there’s some worth to actually taking call on staffing a hospital from a specialty standpoint. I think that’s a good revenue stream in the future, even if elective surgeries are stopped. I think, probably you’ll see a lot of elective surgeries switch over to ambulatory surgery centers, and other avenues like that, where if the resources really are not stretched completely thin to where it’s still safe to do those procedures that add ambulatory surgery centers, I think that’s what keeps alive orthopedics and these other surgical subspecialties.

Keith Landry: Interesting. And that’s a growing trend. You want to talk a little bit about that trend away from the hospital toward the [inaudible] centers?

Joe Greene: Yeah, yeah, absolutely. I think that trend was starting, probably in the last five years, where all of a sudden when I started my training joint replacement patients were in the hospital for at least three days, if not longer. And then, a large majority would go to a rehab facility versus through my training that shifted to where people were staying three days or less and going home for the most part. Now, in my practice, most of my people go home the same day of surgery from a hospital setting. We’re really up to about 75%. I do a lot of revision surgery, which is big complicated surgeries. Most of those folks are going home the next day now, too. There’s really been a big shift from getting people out of the hospital to the home environment where they can recover.

We do that through a variety of different techniques, including nerve blocks, pain injections, multimodal pain control to help people get up and more functional quicker with less pain. And so, that’s the goal. What that’s allowed is a shift from traditional surgeries that had to be done at a hospital to surgeries that can be done in an ambulatory surgery center. And so, you see more and more orthopedic and spine surgeries being done at these centers where people are really having great outcomes and it’s also very cost-efficient. You’ll see, I think, in a push, employers and insurance companies start to even encourage patients to have orthopedic procedures at these inventory surgery centers.

Keith Landry: Interesting. Getting back to COVID-19 and experiencing that pandemic while working in a hospital, I want to talk to you a little bit about the use of telemedicine by hospital systems and what you observed while you were in the hospital over the last few months. Some of them were already doing it regularly. In general, it’s been an observation that, across the country, many of them just very quickly ramped to respond to COVID-19. In your case, was your hospital forced to accelerate its telemedicine strategy or were you already doing it quite extensively?

Joe Greene: No, really, to be honest, we were doing no telemedicine, especially within the orthopedic realm, except for phone calls where we check in on patients. But really, a video conferencing, billable, telemedicine visit, we were not participating in as a practice. And so, yes, this just sped that up light years, really, from where we were personally. I think it’s been a great thing. It was a great thing during those times where patients were nervous, especially for people that were in the postoperative acute phase of recovery, where you could call them, talk to them, they could see your face, explain what was going on and then actually have a somewhat personal dialogue back and forth. So yeah, that definitely accelerated.

We were a little bit slow to adopt, because my healthcare system uses a specific EMR Epic, which took some time to adapt our system, and get the cameras in place, and go through the whole rigmarole, which a large healthcare system has to go through.

I think more fluid private practices, where there’s a little less bureaucracy to get through, so to speak, were able to very, very, quickly roll that out. Even some of my colleagues that are 70 years old that are practicing orthopedic surgeons, they immediately jumped to telemedicine where they had tons of success just by using your iPhone, or an iPad, or smart technology where the government did release some of the restrictions on HIPAA, so that was enabled where you could actually take care of patients. So yeah, I think that completely accelerated a path of telemedicine.

Keith Landry: Interesting. I’d like to switch gears just a little bit to a topic that maybe some of our listeners haven’t heard a lot about, but talking about rural hospitals and hospitals maybe in smaller cities, not in the big urban areas, where some hospitals are having trouble competing against those larger urban hospitals with deeper pockets to pick up specialists to cover on call, the ER coverage 24/7 on call system. First of all, what’s that look like at your hospital? Have you ever had challenges finding doctors to cover the ER on call system 24/8, or not an issue for your team?

Joe Greene: Not really an issue for us and my team, just because of the practice. We have six partners. We have some physician assistants. We have training physicians that work underneath us. So, the ER’s covered pretty easily. We are a level three trauma center. So, if you start talking about call burden, if you talk about a level one trauma center, those are the big, huge, hospitals where they take care of people with gunshots, people that have plane accidents, motorcycle accidents on expressway. Those are the hospitals that really see the humongous accidents and injuries that need immediate care in the operating room that’s life threatening problems. At a level three hospital, that’s more of an hospital where somebody has a slip and fall. They break something. Maybe a minor car accident, something like that. So, it’s not the middle of the night acute emergencies where you need multiple different specialties rushing into the operating room to do procedures. So really, the call coverage is not as burdensome as it would be if you were at one of those humongous level one hospitals.

So yeah, but we divide and conquer. We all have specialties within our practice. We have shoulder specialists, foot and ankle specialists, hip and knee experts. And so, the more complicated procedures we delegate to who gets that based upon their specialty. And so, that seems to work pretty well.

Now, I see your point completely with rural hospitals, because I think, yes, you’re right. I think as medicine goes into a very sub-specialized sect where people are doing much more specific specialties and procedures. In orthopedics, we joke around there’s going to be a right big toe surgeon, left big toe surgeon. I mean, that’s really where we’re going. I mean, I do probably 80% knee surgeries now. I have one partner that only does hip surgeries, and another partner only does shoulder surgery. We truly are becoming very sub-specialized. I think that’s going to cause problems for these smaller hospitals where those surgeons are expected to do everything as well as cover the ER, and if they can even find coverage. Yeah, go ahead [crosstalk 00:16:31].

Keith Landry: There’s an interesting trend. It’s a growing trend. We’re seeing this in these rural hospitals where they’re using telehealth visits. Basically, I’m the on call doctor for the emergency room, but I’m at my house. I’m on call, but I’m not at the hospital. I’ll do some telehealth visits with a patient before they get to the hospital to determine if it’s a super serious injury or maybe it isn’t. The thinking is it gives balance to these 24/7 on call ER docs, while decreasing the backup of people sitting in the emergency room. Do you think that’s a good concept?

Joe Greene: Yeah, I do. Especially for a place… I mean, I think that’s a good concept probably for any system, not even healthcare, but any system that needs to do some form of risk stratification or categorization on timing. I think a screening mechanism is a good thing. I think that’s probably what the telehealth will do in this situation is, okay, let’s use an expert to identify what is a serious acute emergency that needs to be treated right away, and then get that person to the right facility, versus something that could be more of a, we’ll see what happens, then potentially get you into the office at a later date. Like the next day, go to an immediate care center versus the emergency room. So yeah, I absolutely think that’s probably the future of medicine.

Keith Landry: Awesome. Let’s switch gears for a second. You’ve been with the hospital system for about eight years. I want to get in a question here that’s specifically for our medical residents, so they can get a little wisdom from you. When you came out of medical school and you went into the hospital system, were there some surprises for you in that first year in the hospital system, being a new doctor? Are there some little nuggets you can share that someone who’s a medical resident, or about to go into the hospital system, that you can share with them?

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Speaker 1: I think, I took a lot of call when I first started, because as an orthopedic surgeon, it’s an elective practice, and so you don’t have everybody in the city showing up your first day to your office saying, “Would you please do my hip and knee replacement?”, when you’re fresh out of your training. You have to build your reputation. And so, my recommendation is shake hands and kiss babies. By doing that is you go out and you meet primary care physicians, if you’re a specialist. If you’re a primary care physician, maybe you meet some of those specialists. I think more patient encounters and more opportunity to get to know people increases your practice greatly. I would really look for a practice where you seem to be a good fit. And so, really that’s the key. I don’t really necessarily think it’s healthcare system versus private practice, but you need to find a group of people that you enjoy working with and that seem to be of the same mentality that you have to be happy on a day to day basis.

Keith Landry: I think that might be the most important nugget of this entire podcast. That is so true with any career. We tend to break things down by categories and look at them by categories, hospital system versus practice. You nailed it there. There’s got to be some kind of balance between what you’re doing, the work, and the relationship, and the philosophy of the people you’re working with.

Joe Greene: Yeah, absolutely. You want to be able to turn the reins over to somebody else that you think has a similar philosophy of treating patients, staff, and your other partners once you’re off duty, so to speak, and feel confident doing so. And so, I really think that’s the key is to get to know your partners, know the practice, and then make a decision.

Keith Landry: Interesting. And so, when you start in that first year in the hospital system, out of med school, you’re shaking hand, you’re kissing babies, you’re sending out birthday cards, doing anything you can to get that traction, what about the support that comes with that larger hospital system? How did that affect the way that you built your practice and honed your medical skills?

Speaker 1: Yeah, I think there’s already a built in network of primary care doctors. I went around and said hello to all of them and introduce them myself, said, here’s my specialty. This is what I do. And then, I think you can easily send referral notes to those physicians within the healthcare system. I got involved with some committees within the healthcare system. I would go to committee meetings for whatever surgeons or physicians want to do. For me, it was infection prevention committees, as well as outpatient procedure committees, hospital efficiency committees, that kind of stuff. Because, then you get to go and you’re on committees with other physicians and nurses. They get to know you, and they get to know you’re up to date on the current literature and trends within medicine, and that you’re “cutting edge.” And so, I think once you do all of those activities, all of a sudden your name starts percolating amongst patients, and physicians, and nurses, and everybody at the hospital. And then, all of a sudden, you become a referral target.

Keith Landry: Awesome. You’ve been in the hospital system eight years. What are some of the trends you’ve watched, how practicing orthopedic medicine in the hospital system has changed over the last eight years? Where do you think it’s going in the next few years? What are you honed in on?

Speaker 1: Yeah, I think that we touched on before, but subspecialization where I think there’s going to be more and more of that in the future, where you’re not going to see hip and knee surgeons anymore. You’re not going to go see the orthopedic surgeon. You’re going to go see the knee guy, or you’re going to see the hip guy, the shoulder guy, or the wrist guy, or the elbow guy. I think you’ll see that. I think you’ll see more and more orthopedic surgery being done on an outpatient basis, just because I think patients are going to want to go home. We’re going to hone some of our nerve blocks and anesthesia techniques where people are a little bit more comfortable, so they can get home to their home environment, as well as cost savings, I think for insurance companies. I think that’s where the future of orthopedics lies is in outpatient procedures and potentially more telehealth, telemedicine, like we’ve talked about here, and then sub-specialization.

Keith Landry: Interesting question, with all this specialization, this brings more choices for patients, ambulatory care, different options on where to have that surgery. How does the flexibility in that broader range of options for the patient to choose how they get care and where they get care affect how you run your practice?

Joe Greene: I think it’s all about education, right? I don’t know anything about insurance or being an attorney. I really rely on finding somebody who I trust and I have a rapport with. And then, I ask them questions, and I’ll let them steer me. I think that’s part of our job as physicians is that, when we talk with patients, not only are we talking about, okay, well, here’s what your problem is, here’s my recommendations, here are your options, but then also now we have this new relationship with discussing with how and where the procedure is going to be done, what the outcomes are, why I think one way is probably the best. Then, we have to figure that out and do that dance with the patients.

I think a lot of that’s going to be even some information stuff that we’ll put on our website that will walk a patient through a normal course of what happens with a knee replacement. What do you do the morning of? What happens at the hospital or the surgery center, where you get a nerve block? Then the procedure, if they want to watch that, which not all patients want to watch orthopedic surgery. It is kind of fancy carpentry, so it comes with power tools. Some people don’t want to watch that, which is fine.

And then, you see the recovery process of, well, what happens when you wake up? Okay, what do you do with a therapist? How do you get home? And then, what’s a typical course? Is it normal for you to have a lot of bruising after joint replacement? Which is absolutely normal. I think a lot of that is educational support material that you can provide on either through pamphlets or internet base, which I think will probably the future.

Keith Landry: Dr. Greene, thanks for giving me the heads up that I absolutely never want to witness any kind orthopedic surgery.

Joe Greene: There you go.

Keith Landry: That is brutal.

Joe Greene: You have two different camps. You have the people that are interested in and they want to see it big time. And then you have the people, like you, that say absolutely not. No way. I’m turning that off. It’s a choose your own adventure book. You could either go down that road or you could not.

Keith Landry: And it’s good to know you’re sharpening the blades on all your saws regularly.

Joe Greene: Oh yeah. They’re new ones. Everybody gets a new one for the record.

Keith Landry: That’s great. All right, Dr. Joe Greene, if folks want to find out more about your practice, and what you’re doing, and some of the specialization you do, how can they get ahold of you?

Joe Greene: Yeah, I think the easiest way is just to Google me. Joseph Greene, G-R-E-E-N-E MD, in Louisville, Kentucky. I think right now that’ll take you directly to the Norton Healthcare portal, which will give you a little bit more information about me and my practice. There’s some clips of videos that I’ve done. There’s some local media outlet stuff where I’ve been on the news and talked about different injuries and procedures. There’s some links to that kind of stuff. We are developing a website, too, that I think will have more of that patient education video content here in the next few months. That’s another avenue. I would just use the Google machine right now. That’s probably the easiest way.

Keith Landry: And it’s effective. Dr. Joseph Greene, Dr. Joe Greene, appreciate your insights to help our listeners build a successful orthopedic practice. It has been a pleasure visiting with you today.

Joe Greene: Yep. Thank you very much for having me. It’s been fun.

Keith Landry: All right. So, the thunderstorm was going the entire time. The entire time we were recording.

Joe Greene: You did a good job. You didn’t get distracted at all. I didn’t here it on your video either.

Keith Landry: I mean, good lord. Really? The whole time, not just five minutes. Hopefully, we’ll be able to use it. I’ll have to bump it by our team, because it was great. It was perfect. Do you want to try… Frankly, I’m just not sure that it makes sense to try the video.

Joe Greene: Okay. Let’s just do it another time.

Keith Landry: With the thunderstorm rolling in the background.

Joe Greene: Yeah, yeah. That’s fine. Why don’t we see how this audio turns out and then maybe we can do it again in the future.

Keith Landry: Well, let’s just do this. Let’s just do it.

Joe Greene: Okay, sure.

Keith Landry: You don’t have to come back and reschedule it. I mean, I know there’s not going to be any way to edit it out, but let’s just give it a shot.

Joe Greene:  Sure. Sounds good. Where are you from originally? You do not have a Kentucky accent.

Keith Landry: I’m from Boston.

Joe Greene: Oh, okay.

Keith Landry: Yeah. Closest I got to you was Carbondale, Illinois and Paducah, Kentucky.

Joe Greene: Paducah? What were you doing in Paducah?

Keith Landry: I was working at a TV station in Carbondale, and Paducah was part of the TV market. So Metropolis… No metropolis was Illinois. Wasn’t it?

Joe Greene: Okay. Yeah.

Keith Landry: Paducah, Kentucky.

Joe Greene: Oh yeah.

Keith Landry: All right, Nick, I’ll be done in five minutes. Okay? All right, buddy. I’ve only got one in here. You’ve got three.

Joe Greene: Gotcha. Yeah. They’re there watching shows though, so I should be good.

Keith Landry: All right. Well, let’s see. Maybe we’ll get lucky in the next 15 seconds. The storm will just magically roll away.

Joe Greene: Okay.

Keith Landry:  All right. Hello, everyone. Nick, go away. Come on.

Joe Greene: I get it, man. It’s about every time I’m trying to do meeting too.

Keith Landry: Here we go. I’m Keith Landry. Thanks for joining us. We’re talking about hospital systems in the COVID-19 era. What a year it’s been in 2020. We’ve got a gentleman here who’s been working in hospital systems the last eight years, and knows about this firsthand, and what he’s seeing this year in 2020. Dr. Joe Greene is a hip and knee surgeon with the Norton Healthcare System in Kentucky. Thanks for joining us today.

Joe Greene: Yeah, Keith. Thanks a lot for having me.

Keith Landry: You bet. Wild year. I think on January 1st, there probably wasn’t a healthcare provider in America who knew what they were in for in some of these larger cities across the country. What are your observations about what we’ve learned inside hospital systems, and at yours, from the COVID-19 era?

Joe Greene: Yeah, I think we’re still an unchartered waters, for sure. I think that, luckily, the rates did not spike initially where we saw concerning things in New York City and California. In Kentucky, we did not have the spike of patients coming through the emergency room or use of ventilators. So, we were able to keep our census in the hospital very low. And so, it was really about 25% busy at the hospital. And so, we stopped elective surgeries, which I thought was the right call, just to make sure we had enough supplies in case that surge came. But it didn’t show up so far in Kentucky.

Now, hopefully nothing happens here in the future, in the fall or the winter. But, as of right now, we’re back to full tilt. I think our hospital really does not have too many COVID patients in there. We don’t have a whole lot of sick COVID patients, and we’re back to I’m a 100%, or 125%, of our elective business.

I think that we were already doing a lot of outpatient joint procedures prior to COVID, meaning do the patient surgery in the morning, make sure they’re doing well with anesthesia, walking, and then get them actually home the same day. So, same day joint replacement surgery. And so, we were already doing that before, but now there’s an even more of a push and patients are requesting it. They’re doing great, and the outcomes look very good. If you look at-

Keith Landry: Does the COVID… I’m sorry.

Joe Greene: No. That’s okay.

Keith Landry: Does this COVID-19 pandemic change business models in orthopedic surgery across America to force patients out of hospitals into these offsite locations and so on?

Joe Greene: Yeah. Well, I think you can do it from a hospital setting too. I think a hospital system can discharge patients the same day, which is what we’re doing .but you have to build the infrastructure to do that. I don’t know if it forces patients out of the hospital in a negative connotation, but it does accelerate or force healthcare systems to develop that platform and the support for the patients to go home the same day. So yes, I think that’s going to happen. I think also there’ll be more joint replacements done at offsite ambulatory surgery centers. I do think that will be a future thing we’ll see as well.

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Keith Landry: How did the COVID-19 pandemic affect the way you run your practice?

Joe Greene: Yeah, I think telemedicine is something that’s here to stay. We were very much accelerated into telemedicine before this. We really were not doing any through the health system that I work for currently. Now, we are, and we’ve maintained that. I think that your initial followup visits, postsurgical patients are going to be great for telehealth for orthopedics, because our patients from the hip and knee perspective are sore. It hurts when they walk. Having them come into the office two weeks after surgery just to take a look at their incision and do a little bit of education, which you could easily do on a telehealth platform, makes total sense. And then, if you start extrapolating out to guys like you and me that are working throughout the day yet here’s our computer, we can easily do a telehealth visit to see how your rotator cuff’s doing six months after surgery. I can see your range of motion right now, make sure things are progressing, give you some tips. You can fire questions at me. I mean, it’s a modern way of doing medicine, and I think it’s here to stay.

Keith Landry: Interesting. We’re seeing the second wave of infection spikes in cities across America. One of the things we’re seeing that’s in the news right now is these concerns that patients aren’t doing preventive screenings and they’re not doing followup visits. They’re going back to the mentality of being afraid to go into offices again. How concerned are you about that, when you see a trend of patients not getting preventive screenings or followup visits and things like that?

Joe Greene: Yeah. I think that’s a big concern for primary care health providers or some specialties that manage the longterm chronic diseases. In the world of orthopedics, we really treat arthritis and we treat people that are in pain. And so, I think most of my patients are going to come see me if they’re really, really hurting. I am concerned that somebody who has asthma or lung issues are scared of going into seeing their pulmonary specialist or primary care doctor. I think that could cause some problems long term. And so, I think some of that might be able to be handled on telehealth platforms. In the world of orthopedics, though, I think patients are going to seek me out due to a pain level.

Keith Landry: Yeah, I think that’s a great point. One last question for you, Dr. Greene. As you look at the last eight years of practicing medicine in a hospital system, and you’ve observed the evolution of how those practices are going, what are the trends you’re watching for the next few years that you’re really honed in on?

Joe Greene: Yeah, I think you’ll see more subspecialization. I think you’ll see people start to focus on really subspecialties within specialties. And so, you’ll have guys like me, which probably in the next five years, I’ll be a knee physician. That’s all I do is knee surgeries. I’ll probably only do knee replacement surgery. And then, I have a partner who’s going to do only shoulder, and a partner’s only hip. I think you’ll see that. I think you’ll see a push where more and more people are going home the same day of surgery. I think you’ll see more outpatient surgeries being done on the orthopedic front. I think you’ll see some more innovative, smaller, less invasive surgeries. I think you’ll see more and more technology and operator room too on the orthopedic side, like robotics navigation, computer assisted surgery. That kind of technology, I think, will be more prevalent in operating rooms. Those are the kind of trends that I see in the next few years.

Keith Landry: Wow. Everybody in the orthopedic world is going to be on their toes. Dr. Joe Greene, thanks so much for your time today. Appreciate your insights and giving us some great insights on the evolution of orthopedic medicine. Thank you so much.

Joe Greene: Yeah. Thank you very much for having me, Keith. It’s been fun.

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