Orthopedic surgeons, patients and device companies want to know when elective surgeries will be resumed.
American Academy of Orthopaedic Surgeons President Joseph A. Bosco, III (Joe), M.D., told Academy (AAOS) members on April 13 that while it appears the curve of new coronavirus infections is flattening, no one knows when elective surgeries will resume. The following day the Academy sent a letter to congressional leaders asking for more financial help for the orthopedic community. More on that below.
Timing of Resumption
A few days ago, we reported that institutional investors were calibrating when elective surgeries will start coming back. The consensus was that about 50% will be back on schedule by the end of May and that the remainder will work their way back over the ensuring 60 days. “Assuming, and this is a massive assumption, that strong mitigation efforts remain in place wherever COVID-19 exists, then the risk of a strong second wave—strong enough to disrupt this timeline—is low. A lot is riding on what happens at the Federal level,” wrote our publisher.
Earlier in the month the Institute for Health Metrics and Evaluation predicted there will be rolling COVID-19 peak between April 15 and May 22. Some elective surgeries could be back on schedule by May 23.
Governors and state legislatures will determine the schedules for allowing elective surgeries to return, despite the President’s constitutionally injurious claim of absolute authority in making that decision. States will also define what constitutes an elective surgery. At this point many states have adopted the Centers for Medicare and Medicaid Services (CMS) definition of elective surgery and which surgeries should be postponed.
CMS recommends three tiers of postponements.
- 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.
The Administration controls the purse strings of Medicare and Medicaid, so CMS’ participation will be required if surgeons want Medicare and Medicaid reimbursements.
Bosco has assembled a small task force of AAOS Board members which included Drs. Daniel Guy, Felix Savoie, James Ficke and Alex Vaccaro to create a comprehensive guide to help members determine what constitutes elective surgery.
