Adopting Accessible Digital Tools to Close Gaps in Orthopedic Care Postpandemic

The pandemic prompted an uptick in telehealth use that improved access to care for many patients, but it also exacerbated existing disparities for underserved populations who do not have smartphones, a network connection, and other technology, says Bronwyn Spira, PT.

From an orthopedic care perspective, Ms Spira explores barriers to patient access and advocates for affordable, widely accessible digital solutions to better meet the needs of underserved populations.

What barriers have prevented patients from seeking orthopedic care?

Many patients, especially low-income and underserved populations, experience barriers to improving their health. Some are structural barriers such as lack of access to transportation and difficulty getting time off work to attend in-person doctor visits. Individuals may have physical or functional impairments that make it difficult for them to drive or board a bus to get to their appointments. There are also financial impediments such as the cost of copays, transportation, childcare, and absence from work. These barriers can be a huge challenge to overcome, even more so for those who are uninsured or underinsured.

More than 50% of the US population has a musculoskeletal (MSK) injury that needs some type of orthopedic intervention. Research shows the risk of developing long-term physical disabilities by neglecting to address MSK diagnoses is significantly higher for Black and Hispanic individuals as compared with White individuals, emphasizing how racial and socioeconomic disparities impact population health.

How did COVID-19 affect access barriers?

The COVID-19 pandemic shone a spotlight on how telemedicine and remote patient monitoring tools could improve access to care. People were often not comfortable going to a hospital or a doctor’s office to see their providers in person, so they had to find alternative ways of getting care. Telemedicine was a quick and easy fix to replace in-person visits with virtual visits, and many health systems adopted commercially available telemedicine platforms. Regulatory barriers were relaxed, and the Centers for Medicare & Medicaid Services (CMS) announced telehealth visits would be reimbursed in parity with in-person visits during the pandemic. Providers realized they had little choice but to adopt digital visits to care for their patients. 

Of course, some low-income patients did not have access to a network connection, computer, or smartphone, and this remains an issue today. 

How would you say barriers to orthopedic care access impact outcomes and the industry overall?

If patients cannot access the right care and information and cannot be treated in a timeframe helpful to their condition, their outcomes are significantly impacted. Patients who are well-educated and engaged in their care have much better outcomes. It is imperative that we provide patients with the right information from their treating providers in a format that is accessible and digestible.

How can providers, health systems, and/or payers help improve access to orthopedic care?

Provider organizations must develop and embrace digital infrastructure that can help them connect with their patients. Providers need to establish workflows and processes that allow them to either use digital technology as a framework or have digital technology as an adjunct to in-person care.

There are obviously many components to that; one is reimbursement, and the other is regulation. We saw progress on the regulation front during the pandemic to support the use of telehealth. Then CMS introduced Current Procedural Terminology (CPT) codes for remote therapeutic monitoring, enabling reimbursement for time spent engaging patients and monitoring patient-reported nonphysiological data remotely. 

As remote care is increasingly accepted and reimbursed, a wider range of patients can access the same high-quality, personalized care. I think there is positive momentum, but we are still in the beginning stages of strengthening the relationship between providers and patients.

Regarding access to orthopedic care, where do you see the future headed?

We are not going back. Digital care is just part of care now. We need to make sure underserved populations have access to digital care as well as brick-and-mortar care. 

We must create broadband networks that are widely accessible and low-cost plans for cell phone usage to ensure digital technology can be accessed in multiple modalities, not just a computer or smartphone. Also, digital care platforms must support patients who experience socioeconomic barriers related to education, language, and the ability to engage a care partner. These considerations are important for providing a comprehensive digital health experience. 

As we consider the next iteration of care, all of this must be built with patients and providers in mind. We must improve the relationship between patients and providers in a digital framework and not exclude the provider from that conversation. Digital care in a box can have negative impacts, such as a patient receiving care not specifically designed for their condition or diagnosis. Using digital tools to engage patients in care prescribed by their own provider and individualized to their needs leads to better outcomes and higher patient satisfaction.

About Ms Spira

Bronwyn Spira is a physical therapist and the founder and chief executive officer of Force Therapeutics, a provider-prescribed digital care management platform that empowers patients throughout an episode of care.