Becker's ASC Review

39 ORTHOPEDICS Spine surgery in the next 3 months: 6 observations By Laura Dyrda H ere are six observations for spine surgeons on the COVID-19 pandemic and where the industry is headed in the next several months. 1. Returning to elective surgery requires patients to have access to physical therapy, and in many cases that means virtual therapy ses- sions. CMS expanded its list of telehealth services covered for virtual visits to include physical therapy for Medicare beneficiaries in April. 2. In May, spine surgeons across the country were planning to resume their procedures and figure out how to update their backlog of cases. ere are several considerations based on national, state and local guidance; however, as COVID-19 tests become available, surgeons will be able to accelerate their case load. "Pending testing capacity, it is our intent to do COVID-19 testing on all elective patients, followed by a 48-hour self-quarantine between testing and the day of surgery," said Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute. "Initially we expect to start at 50 percent of a surgeon's typical daily elective caseload to allow for more extensive room cleaning between cases. Our priority initially will be to reassure patients that we can safely address their care needs. As we develop that confidence and trust with our patients, employees and physicians, we will accelerate the ramp-up." 3. Texas Back Institute in Plano has implemented a socially distanced check-in process and screening and PPE strategy for patients and staff to ensure a safe return to clinic visits and surgeries. e practice also tailored clinic schedules to include both face-to-face and tele- medicine encounters and stratified cases into low-risk and high-risk patients based on their susceptibility to COVID-19. 4. Device companies reported first quarter earnings, with significant negative impact from the pandemic. • Stryker reported overall net sales were up 2 percent in the quarter, but could not provide updated guidance for the year. Stryker's orthopedic sales dropped 2.1 percent in the quarter although neurotechnology and spine sales were up slightly to $700 million. • Zimmer Biomet reported a 9.7 percent revenue drop, and the company's spine and craniomaxillofacial sales had already been slowing in recent quarters. • Johnson & Jonson's spine, sports and other sales were down 10.7 percent in the first quarter to $702 million. 5. e "new normal" for spine surgeons is hard to define, but over the next 12 to 18 months surgeons are preparing to initially resume surgical cases and hit a balance between telehealth and in-clinic visits going forward. However, another surge in COVID-19 patients later this year could affect practices and some are preparing for a drop in surgical case volume because some patients will be uncomfortable having surgery until there is a COVID-19 vaccine. 6. Spine surgeons also may see payers push for alternative or at-risk payer models to shi the cost burden to providers and link reim- bursement to sustained performance. "In order to perform well, phy- sician practices should be prepared to quickly engage in robust data tracking and reporting capabilities, the ability to demonstrate consis- tent clinical outcomes and be able to function in a population health type environment where a larger continuum of the patient's care than just the surgical episode is the responsibility of the surgeon," said Jason Scalise, MD, of Phoenix-based e CORE Institute. "Practices without the ability to do so quickly should look for partnerships that allow them to incorporate such resources." n Alphatec ends plan to buy EOS Imaging for $122M, cites COVID-19 By Laura Dyrda M edical device company Alphatec ended its agreement to acquire EOS Imaging due to the ongoing impact of COVID-19. "This has been a difficult, disappointing decision," said Alphatec Chairman and CEO Pat Miles. "Both companies have worked so hard and so cooperatively over many months to bring this transaction together. On behalf of the entire ATEC family, I want to personally thank EOS for its commitment and hospitality throughout this process." Alphatec announced the tender offer agreement to purchase EOS imaging for up to $88 million in addition to $33.9 million of debt retirement on Feb. 26. But the business and healthcare landscape has changed con- siderably since then due to the coronavirus pandemic. After undertaking an analysis of the market effects of COVID-19, Alphatec said it concluded that a material adverse effect, as defined in the terms of agreement, had occurred, and the company decided to terminate its offer. Alphatec sent a letter dated April 24 to EOS to termi- nate the offer. Alphatec and Perceptive Credit Holdings agreed to terminate the commitment letter for up to $160 million in secured debt financing as well, which would have allowed the company to complete the transaction. Alpahtec's current credit facilities remain in place. Even though the acquisition was terminated, Mr. Miles hinted that the companies may continue to work together in strategic collaboration. n

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