Centers for Medicare and Medicaid Services (CMS) wants all elective surgeries, non-essential medical, surgical, and dental procedures to be delayed during the COVID-19 pandemic.
The agency issued the recommendation in a press release on March 18, 2020.
The purpose of the recommendation is to preserve personal protective equipment (PPE), beds and ventilators. Delays of elective surgeries will also free up the healthcare workforce. “The reality is clear, and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.
Factors of Consideration
The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.
3-Tiers of Postponement
The recommendations are broken into three tiers based on the acuity of the procedure and the patient’s health. “Interestingly,:” noted Needham & Company, LLC analyst, Mike Matson, “outpatient procedures are being prioritized lowest by CMS which is counter to the view that some have expressed that these procedures may be less affected.”
Tier one is the “postpone surgery” category and includes procedures such as carpal tunnel release, EGD (esophagogastroduodenoscopy), colonoscopy and cataracts.
Tier two is the “consider postpone surgery” category and includes low-risk cancer and non-urgent spine and ortho (including hip, knee replacement and elective spine) surgery.
Tier three is the “do not postpone” category and includes most cancers, neurosurgery, highly symptomatic patients, transplants, trauma, cardiac with symptoms and limb threatening vascular surgery.
Dental procedures were specifically targeted due to their use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. CMS is recommending that all non-essential dental exams and procedures be postponed until further notice.
Surgeon Decision
CMS notes that decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have direct responsibility to their patients. “However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered.”
CMS suggest that the following factors to be considered as to whether planned surgery should proceed.
- Current and projected COVID-19 cases in the facility and region. Consider the tiered approach described above. The decisions should be made in consultation with the hospital, surgeon, patient, and other public health professionals.
- Supply of PPE to the facilities in the system.
- Staffing availability.
- Bed availability, especially intensive care unit (ICU) beds.
- Ventilator availability.
- Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery.
- Urgency of the procedure.
The American Medical Association (AMA) said the CMS guidance offers needed flexibility to physicians by allowing them to consider the imperative of resource conservation, especially personal protective equipment. “The nation’s physicians know challenging days are coming. We are preparing for it and are grateful that the federal government understands that physicians need to have flexibility when responding to this threat.”
The recommendations can be found here.
