Clinically Speaking

The COVID-19 pandemic has brought with it many health risks, including the risks associated with health care people need but do not access. Nolan Wessell, MD, Assistant Professor in the Department of Orthopedic Surgery and Division of Spine Surgery at the University of Colorado School of Medicine, is working to meet the needs of his patients through virtual spine exams.

Dr. Wessell and his colleague, Vikas Patel, MD, (right) Executive Vice Chair of the Department of Orthopedic Surgery, have been working together to adapt the protocol of the in-person spine exam to work as a virtual visit. To make the visits effective, they needed a new way to gather essential information that would normally be gathered during an in-person visit, such as strength and gross motor skill assessment.

The doctors needed to think creatively about how to adapt the in-person protocol so patients could do the usual strengths maneuvers without the usual equipment.

“We knew we would need a protocol that was easy for people to understand and that used standard household items that everyone would have––a kitchen chair, a heavy book or gallon of milk, a piece of paper, a hair tie,” said Dr. Wessell. “We have a prescribed protocol to ensure that the virtual visit is comprehensive and consistent, including a ‘rooming’ procedure to prepare patients for the visit, test the technology and get the supplies ready.”

Dr. Wessell (right) acknowledges that virtual visits work better for some specialties than others. The virtual visit works well for spine exams because the doctors are testing for gross movement and strength, and do not need to touch the patient to get the information they need. The doctors are able to have patients do the tasks they would do during an in-person visit––walking, bending, lifting––to get the information they need to diagnose problems, guide non-invasive treatment or complete a follow-up visit after surgery.

Dr. Wessell and his colleagues use virtual visits strategically. They work well for consulting on treatment options after patients have X-rays taken at a local clinic, or for guiding non-invasive treatment options such as physical therapy. They still want to see patients face-to-face before recommending an invasive treatment such as surgery.

The opportunity to innovate around virtual visits came as a result of relaxed restrictions for Medicare coverage for telehealth services during the COVID-19 outbreak. Dr. Wessell believes that virtual visits can continue to be an important tool for assessing and treating spine conditions even post-pandemic, after in-person visits are once again safe. He hopes that Medicare will continue to cover virtual visits, even for patients who live outside of Colorado––a limitation that has been an obstacle in the past.

“The spine care team serves patients from a wide geographic area, including rural areas across several states,” said Evalina Burger, MD, Professor and Chair of the Department of Orthopedics. “It is difficult for patients to travel many hours for a brief consultation. Virtual visits can open up orthopedic care to people who might otherwise go without the care they need.”

To lay the groundwork for continued coverage of virtual visits, Dr. Wessell and his colleagues are doing a formal study to look at the virtual visit’s effectiveness in meeting diagnosis and treatment goals. They are looking at both patient satisfaction and diagnostic data to show that virtual visits are equally effective as in-person visits for assessing neurological deficits due to spine problems. The team has approval for a study that they will begin soon.

Dr. Wessell looks forward to completing the research. “We hope this study gives insurers the evidence they need to confidently cover virtual visits and make a difference for many patients.”