Orthopaedics has been severely impacted with a moratorium on elective surgery and related issues, including but not limited to: cash flow, staff reductions, the management of non-acute pathology, the implementation of telemedicine and more. The clinical and economic ramifications present an existential threat to our orthopaedic practices and our ability to deliver medical services. AANA wants all practices to continue weathering this storm while preparing to resume patient care as the acute phase of this crisis passes.

We have assembled an amazing panel of AANA Leaders to discuss the transition back to office work, clinical activities and arthroscopic-related procedures. Regional differences and relative urgency for various clinical conditions will be discussed as well as new safety measures, changes in business models and more.

Please listen to learn how these leaders are preparing for the next phase in managing challenges due to this unprecedented outbreak.

Louis F. McIntyre, M.D.
Moderator; Northwell Health; Immediate Past President, AANA

Brian J. Cole, M.D., M.B.A.
Managing Partner, Midwest Orthopaedics at Rush; First Vice President, AANA

Mark H. Getelman, M.D.
Southern California Orthopedic Institute; Second Vice President, AANA

James W. Stone, M.D.
Orthopedic Institute of Wisconsin; Treasurer, AANA

Eric C. Stiefel, M.D.
Valdosta Orthopedic Associates; Chair, AANA Advocacy Committee

Nicholas A. Sgaglione, M.D.
Chair and Senior Vice President, Orthopedic Service Line, Northwell Health; Chair, AANA JBOT and Education Foundation

1. What aspects of your practice are up and running currently?
2. How are you "living with COVID-19" and proceeding in the ambulatory surgery center (ASC), office and inpatient settings?
3. Which federal programs have you accessed? Have any delivered proceeds for cash flow yet? How are those being managed?
4. How are your employees tolerating furlough or a reduction of hours?
5. How are you handling resumption of both salaried and hourly employees’ compensation and paid time off during the ramp-up, and how much of this is tied to SBA loan requirements?
6. How are you handling resumption of partner and employed physician compensation during the ramp-up?
7. Have any of your employees or partners developed COVID-19?
8. Will this crisis force you to reassess your business model and practice paradigm in the near-term?

• Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic (PDF)
• CDC Guidelines: Opening Up America Again
• Opening Up America Again - CMS Recommendations - Re-Opening Facilities to Provide Non-Emergent Non-COVID-19 Health Care: Phase I (PDF)
• Keeping the Coronavirus from Infecting Health Care Workers: What Singapore’s and Hong Kong’s Success is Teaching Us About the Pandemic (PDF)
• Current Social Distancing Assumed Until Infections Minimized and Containment Implemented
• JAAOS COVID-19 Articles
• COVID-19 and Elective Surgery Algorithm (PDF)
• CMS Adult Elective Surgery and Procedures Recommendations: Limit All Non-Essential Planned Surgeries and Procedures Including Dental, Until Further Notice (PDF)
• State Guidance on Elective Surgeries
• Elective Patient Care and Surgery in the Era of Pandemics: A Blueprint for Responding and Recovering from SARS-CoV-2 and COVID-19, While Preparing for the Future
• COVID-19: Pandemic Surgery Guidance
• How to Risk-Stratify Elective Surgery During the COVID-19 Pandemic?
• COVID-19: All Non-Urgent Elective Surgery is Suspended for at Least Three Months in England
• Clinical Characteristics and Outcomes of Patients Undergoing Surgeries During the Incubation Period of COVID-19 Infection
• Novel Coronavirus and Orthopaedic Surgery: Early Experiences from Singapore
• Peri-Operative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopedic Patients: Operating Rooms Protocols and Recommendations in the Current COVID-19 Pandemic
• Practice Management During the COVID-19 Pandemic
• Orthopedic Surgery Post COVID-19: An Opportunity for Innovation and Transformation
• Surgery in COVID-19 Patients: Operational Directives
• A Review of State Guidelines for Elective Orthopaedic Procedures During the COVID-19 Outbreak
• COVID 19 in Orthopedics
• COVID-19 Provides an Opportunity to Reassess How Frequent and How Extensive Elective Spine Surgery Should Be
• Global Guidance for Surgical Care Curing the COVID-19 Pandemic

1. Holshue, M.L., DeBolt, C., Lindquist, S., et al. "First Case of 2019 Novel Coronavirus in the United States." New England Journal of Medicine. 2020 March 5;382:929-936. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2001191.
2. Gawande, A. "Keeping the Coronavirus from Infecting Health-Care Workers." The New Yorker, Condé Nast, 21 March 2020, https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers.
3. World Health Organization (WHO). "WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020." World Health Organization (WHO), March 2020, https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
4. American College of Surgeons. "COVID-19: Recommendations for Management of Elective Surgical Procedures." American College of Surgeons. 2020 March 13. Available from: https://www.facs.org/covid-19/clinical-guidance/elective-surgery.
5. Center for Medicare and Medicaid Services. "CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response." Center for Medicare & Medicaid Services; March 2020, https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental.
6. Luthi, S. "Surgeon General Advises Hospitals to Cancel Elective Surgeries." Politico. 2020 March 14. Available from: https://www.politico.com/news/2020/03/14/surgeon-general-elective-surgeries-coronavirus-129405.
7. Ambulatory Surgery Center Associaiton. "State Guidance on Elective Surgeries." Ambulatory Surgery Center Association. 2020 April 20. Available from: https://www.ascassociation.org/asca/resourcecenter/latestnewsresourcecenter/covid-19/covid-19-state.
8. Sarac, N.J., Sarac, B.A., Schoenbrunner, A.R., et al. "A Review of State Guidelines for Elective Orthopaedic Procedures During the COVID-19 Outbreak." The Journal of Bone Joint Surgery – American Volume. 2020 April 13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32282419.
9. CDC, the White House. Guidelines for Opening Up America Again. CDC, the White House. 2020 April. Available from: https://www.whitehouse.gov/wp-content/uploads/2020/04/Guidelines-for-Opening-Up-America-Again.pdf.
10. IHME. "COVID-19 Projections." IHME. 2020 April 17. Available from: https://covid19.healthdata.org/united-states-of-america.
11. Liang, Z.C., Wang, W., Murphy, D., Hui, J.H.P. "Novel Coronavirus and Orthopaedic Surgery: Early Experiences from Singapore." The Journal of Bone and Joint Surgery. 2020 March 20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32205660.
12. Vaccaro, A.R., Getz, C.L., Cohen, B.E., Cole, B.J., Donnally, C.J. III. "Practice Management During the COVID-19 Pandemic." The Journal of the American Academy of Orthopaedic Surgeons. 2020 April 13. Available from: https://journals.lww.com/jaaos/Abstract/publishahead/Practice_Management_During_the_COVID_19_Pandemic.99131.aspx.
13. Gilat, R., Cole, B.J. "COVID-19, Medicine, and Sports." Arthroscopy, Sports Medicine and Rehabilitation. 2020 April 11. Available from: https://www.arthroscopysportsmedicineandrehabilitation.org/article/S2666-061X(20)30026-2/fulltext.
14. American Academcy of Orthopaedic Surgeons (AAOS). "Navigating the COVID-19 Pandemic." AAOS. 2020. Available from: https://www.aaos.org/about/covid-19-information-for-our-members/.
15. Guy, D., Bosco, J.A. III., Savoie, F.H. III. "AAOS Guidelines for Elective Surgery During the COVID-19 Pandemic." 2020. Available from: https://www.aaos.org/about/covid-19-information-for-our-members/aaos-guidelines-for-elective-surgery/.
16. Stahel, P.F. "How to Risk-Stratify Elective Surgery During the COVID-19 Pandemic?" Patient Safety in Surgery. 2020 March 31;14:8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107008/.
17. Brücher, B.L., Nigri, G., Tinelli, A., et al. "COVID-19: Pandemic Surgery Guidance." 4open. 2020 April 10;3:1. Available from: https://www.4open-sciences.org/articles/fopen/full_html/2020/01/fopen200002s/fopen200002s.html.
18. Awad, M.E., Rumley, J.C., Vazquez, J.A., Devine, J.G. "Peri-Operative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopedic Patients: Operating Rooms Protocols and Recommendations in the Current COVID-19 Pandemic." The Journal of the American Academy of Orthopaedic Surgeons. 2020 April 10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32282441.
19. American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. "Joint Statement: Roadmap for Resuming Elective Surgery After COVID-19 Pandemic." 2020 April 17. Available from: https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery.
20. Gilat, R., Haunschild, E., Tauro, T., Cole, B.J. "Safeguards to Optimize Safety of Elective Surgical Care While Limiting the Spread of COVID-19: Primum Non Nocere." Midwest Orthopaedics at Rush University Medical Center. 2020 April 21; 1-14.
21. COVIDSurg Collaborative. "Global Guidance for Surgical care During the COVID-19 Pandemic." John Wiley & Sons Ltd., Wiley Online Library. 2020 March 30. 10.1002/bjs.11646.
22. Illinois Bone and Joint Institute. "Next Steps Toward Re-engagement." Illinois Bone and Joint Institute, 9 April 2020, https://www.ibji.com/covid-19-coronavirus/.
23. Tang, D., Tou, J., Wang, J., et al. "Prevention and Control Strategies for Emergency, Limited-Term, and Elective Operations in Pediatric Surgery During the Epidemic Period of COVID-19." World Journal of Pediatric Surgery. 2020 March 19;3:e000122. 10.1136/ wjps-2020-000122.

The unprecedented disruptions of the outbreak have forced significant and sudden change upon everyone practicing medicine in the U.S. and worldwide. Orthopaedics has been impacted severely with a moratorium on elective surgery and the management of non-acute pathology. The clinical and economic ramifications are presenting an existential threat to our orthopaedic practices and their ability to deliver medical services.

Join a panel of AANA Leaders as they discuss ways to navigate the threats and challenges of the COVID-19 pandemic. AANA wants all practices to weather this storm and remain healthy and viable to ultimately resume the care of patients once the acute phase of this crisis has passed.

We have assembled an amazing panel of AANA Leaders who are on the frontlines managing the response to the pandemic and fulfilling their obligation to patient care. Please listen and learn how these leaders are handling the crisis.

Louis F. McIntyre, M.D.
Moderator; Northwell Health; Immediate Past President, AANA

Brian J. Cole, M.D., M.B.A.
Managing Partner, Midwest Orthopaedics at Rush; First Vice President, AANA

Mark H. Getelman, M.D.
Southern California Orthopedic Institute; Second Vice President, AANA

James W. Stone, M.D.
Orthopedic Institute of Wisconsin; Treasurer, AANA

Eric C. Stiefel, M.D.
Valdosta Orthopedic Associates; Chair, AANA Advocacy Committee

Nicholas A. Sgaglione, M.D.
Chair and Senior Vice President, Orthopedic Service Line, Northwell Health; Chair, AANA JBOT and Education Foundation

1. What cash flow strategies are you employing during the acute phase of the pandemic?
2. How have you handled your human resource obligations?
3. What aspects of your practice are currently up and running?
4. Are you planning on accessing federal assistance programs through the CARES Act? If so, which ones? Any other sources of short-term capital?
5. How are you handling partner compensation during the acute phase?
6. How are you handling both salaried and hourly employees’ compensation and paid time off during the acute phase, and how long are you planning this strategy?
7. How are you handling ancillary services during the acute phase?
8. Are you employing telehealth services? If so, how are they incorporated into your practice?
9. What patient and employee safety measures are you employing right now?
10. What do you anticipate the ramp-up will look like and how will your practice change?