Hospitals Advised to Postpone Elective Procedures During COVID-19 Crisis
Health & Life Sciences Alert 03/20/20 Sarah E. Coyne, Jon R. Kammerzelt
On March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) announced its recommendations that hospitals take immediate action to postpone all elective surgeries and non-essential medical, surgical, and dental appointments and procedures during the 2019 Novel Coronavirus (COVID-19) outbreak.
These recommendations are intended to preserve precious resources—including Personal Protective Equipment (PPE), respiratory supplies and equipment, inpatient beds, and health care staff in general—for the front lines of the COVID-19 response. This recommendation is also intended to keep patients at home as much as possible.
CMS notes that dental procedures, for example, use PPE and have one of the highest risks of transmission due to the close proximity of the health care provider to the patient.
Ultimately, whether to cancel a given appointment or procedure will be a case-by-case determination made by each facility and each practitioner, with patient input. These decisions will need to be guided by the patient's condition, the procedure at issue, the patient's risk factors, and hospital resources. In making the case by case determination, CMS suggests that hospitals specifically consider:
- Current and projected COVID-19 cases in the facility and in the geographic region
- Supply of PPE to facilities
- Staffing availability
- Bed availability, especially ICU beds
- Ventilator availability
- Health and age of the patient
- Urgency of the procedure
The CMS recommendations include a chart setting forth tiers of urgency and give examples for each. For example, low acuity surgery (such as removal of cataracts) with a healthy patient would be "Tier 1a" and would be postponed. In contrast, an unhealthy patient in a hospital needing a transplant would not be postponed (even if not yet to the point of emergent.) Many other factors must be considered in each circumstance, but the guidance sets forth a helpful framework for analysis.
Hospitals have already shifted toward prioritizing resources for managing the surge of potential COVID-19 patients by contacting patients and cancelling non-essential appointments and procedures to free up staff and resources. Already under financial strain from the cost of dealing with the crisis, the cancellation of lucrative elective encounters and procedures will compound the financial challenges. While financial considerations do not come before patient care and crisis management, hospitals need to be financially sustainable, and early proactive management of this issue will be crucial. While the federal government has taken significant steps to address the economics of the crisis in general, the American Hospital Association is calling for direct support to hospitals and others on the front line.
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