Dr. Matt Schmitz, JBJS Senior Editor for Pediatrics and Social Media, spotlights a new study that looks at the increase in communication “touchpoints” in total joint arthroplasty (TJA).
Digital connectedness has changed the way health care is delivered. Patients have access to their medical records and test results and now have new ways to communicate with their surgeon and care team through the electronic medical record and online portals. This communication is critical for improvements in patient care.
In a study conducted at the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, Lam et al. took a closer look at the growing communication workload in orthopaedic practice. They performed a retrospective review of perioperative communication “touchpoints” (encounters made through telephone calls and online electronic messages) among patients who had undergone total joint arthroplasty (TJA) at a high-volume institution. The authors sought to quantify workload created by communication touchpoints and analyze the change over time. The study is in the September 16, 2026 issue of The Journal:
The authors reviewed 277,729 phone calls and 16,966 electronic messages across 45,216 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2016 and 2022, covering the 30-day preoperative and 90-day postoperative periods.
Preoperatively, patients averaged 2.2 phone calls and 2.3 electronic messages. Postoperatively, this rose to 4.4 calls and 2.8 electronic messages. Most strikingly, total perioperative touchpoints per patient more than doubled over the study period, increasing 105% for those undergoing TKA (8.7 to 17.8 touchpoints) and 121% for those undergoing THA (7.3 to 16.1 touchpoints). This was driven largely by a threefold rise in postoperative phone calls per patient.
Regression analysis showed that patients who underwent TKA and those who had outpatient procedures generated significantly more touchpoints, while older age, male sex, higher body mass index (BMI), and Medicare insurance (vs. commercial) were associated with fewer touchpoints.
The authors note that the surge may be attributed in part to the national shift toward outpatient and same-day-discharge TJA, which increases patients’ reliance on remote communication during recovery. They argue that current CPT-based bundled reimbursement models fail to account for the escalating administrative workload, especially as per-procedure reimbursement has simultaneously declined. They emphasize that future policy discussions should acknowledge the increasing time spent on communication touchpoints. Among suggestions mentioned is the use of CPT codes for recording “check-in” services to highlight touchpoint volume, or attaching CPT add-on modifiers when utilization exceeds touchpoint thresholds, to improve reimbursement.
Limitations include the study’s single-institution, retrospective design and that the database did not separate touchpoints by which staff member handled them, although the authors acknowledge that physician extenders, nurse navigators, and administrative staff handled most of the messaging. The authors concluded that, without systemic reform, rising communication demands risk overwhelming practice staff, which could ultimately affect care quality.
While I don’t agree with recent cuts to reimbursement across the board, I’m not sure I agree that we should be paid more for open lines of communication, which should be part of patient care. It’s important that our patients can have their questions answered in a timely manner, or their anxiety decreased knowing that they can reach their surgeon and team. This is better for our patients, and the study shows that patients are clearly utilizing these communication channels.
You can find the full study and the related video abstract at JBJS.org: Surgeons May Be “Touched Out”: The Ever-Increasing Workload of Telephone Calls and Electronic Messages in Total Joint Arthroplasty
Additional perspective on this study:
Commentary by Robert C. Schenck, Jr., MD: Nobody Said It Was Going to Be Easy
JBJS Senior Editor for Pediatrics and Social Media