CMS, AHA and ACS Announce Roadmap to Restart Elective Surgeries

One of the biggest casualties of the new coronavirus has been elective surgeries.  Suspension of these surgeries has caused hospitals to lose billions of dollars in revenue. Now the American Hospital Association, AHA, the American College of Surgeons, and other groups have released a roadmap to guide health care facilities on the road to resumption of elective surgeries.

Working with the Centers for Medicare and Medicaid Services, the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), the Association of periOperative Registered Nurses (AORN), the AHA noted in a joint statement that when the first wave of the COVID-19 pandemic is over, there will be pent-up patient demand for surgical and procedural care.  Health care organizations, physicians, and nurses must be prepared to meet this demand.

What the Roadmap Entails

Among the principles for re-opening elective surgeries is that there should be a sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days, and the facility must have appropriate number of intensive care unit (ICU) and non-ICU beds, personal protective equipment (PPE), ventilators and trained staff available to treat all non-elective patients without resorting to a crisis standard of care.

In addition, a facility that seeks to restart elective surgeries should use available testing to protect staff and patient safety whenever possible. In addition, the facility should implement a policy addressing requirements and frequency for the patient and staff testing. Furthermore, hospitals are advised against the resumption of elective surgical procedures until they have adequate PPE and medical-surgical supplies appropriate to the number and type of procedures to be performed.

“Facilities should establish a prioritization policy committee consisting of surgery, anesthesia and nursing leadership to develop a prioritization strategy appropriate to the immediate patient needs,” one of the principles says.

Following the outbreak of COVID-19, the CMS recommended limiting non-essential care and encouraged the use of telehealth.

However, CMS administrator Seema Verma pointed out that “the reality is that not everything can be addressed by telehealth” noting that there was a need to resume elective surgeries such as for breast cancer and cataracts.

“Every state and local official has to assess the situation on the ground. They need to be able to screen patients and healthcare workers for the COVID virus, and we need to make sure that patients feel safe when they come in to seek healthcare services by showing they have the appropriate cleaning in place and that they observe social distancing inside the healthcare facilities,” Verma said.

Some States Resume Elective Surgeries

West Virginia has become one of the first states to say it is resuming elective surgeries. Governor Jim Justice issued an executive order allowing hospitals to resume elective procedures. However, hospitals have to be reviewed by state officials before these procedures can resume. Indiana has also announced that it is easing restrictions on elective surgeries.

Due to the coronavirus, hospitals were forced to suspend elective surgeries, but this has hurt many facilities’ bottom lines.

The Illinois Hospital Association estimates that, due to the cancellation of elective surgeries, hospitals in the state have lost $1.4 billion in revenue. Illinois canceled elective surgeries effective March 19.

In an effort to restart elective surgeries in Illinois, Mercyhealth proposed a plan to accommodate all local COVID-19 patients in one of its hospitals, while its other companies will begin surgeries. To see the plan through, Mercyhealth asked OSF Saint Anthony Medical Center and SwedishAmerican Hospital to join in its plan, but the two facilities have reservations.

Due to reduced revenues, hospitals have been forced to take cost cutting measures, such as furloughing workers.  In some cases, executives have had to take pay cuts. Executives at OSF HealthCare have taken pay cuts; Lurie Children’s Hospital has sent home a fifth of its staff on full pay. Loyola Medicine furloughed primarily nonessential, nonclinical staff, reducing hours for other staff, and reduced executive pay.

Loyola said furloughed workers will continue receiving health, dental, and life insurance benefits. “We hope to bring back as many furloughed employees as we can, when possible,” the Chicago Tribune reported.

Projections from the University of Washington’s Institute for Health Metrics and Evaluation forecast that Illinois will be able to relax social distancing protocols from May 25.