The federal government this week offered a glimpse into how non-emergency medical procedures, temporarily banned amid the COVID-19 pandemic, may resume in certain parts of the country.
The Centers for Medicare & Medicaid Services (CMS) released guidance for how health care providers should prioritize non-coronavirus care once their specific region hits Phase I of the White House’s three-phase economic reopening model, released last week.
CMS temporarily banned “all elective surgeries, non-essential medical, surgical, and dental procedures,” on March 18, with the goal of reserving hospital and intensive-care capacity exclusively for COVID-19 cases.
“By complying with our recommendations to postpone non-essential elective surgeries, our health care system has made a tremendous sacrifice. We owe both those on the front lines and those who postponed procedures for the sake of their colleagues a profound debt of gratitude,” CMS administrator Seema Verma said a statement released Sunday. “Today, some areas of the country are experiencing fewer cases and lower incidence of the virus, necessitating a more tailored and flexible approach.”
Under the terms of CMS’s guidance, operators in areas with ebbing coronavirus cases should work to create “non-COVID care” zones, or NCC zones, in which certain kinds of surgeries and care could be provided. Providers would be required to screen both patients and all staff — from doctors and nurses to delivery workers — for signs of the virus, with routine testing once “when adequate testing capacity is established.”
That latter point is crucial, given that people with no COVID-19 symptoms can still pass the virus to others — a factor that has been singled out as a main cause of widespread outbreaks at nursing facilities across the country.
Operators and local health officials would also be required to triage the kinds of non-coronavirus care that they can provide. Surgeries, procedures, and complex chronic care management sit at the top of the priority list, followed by “select preventive services” and other interventions.
“Patients continue to have ongoing health care needs that are currently being deferred,” CMS observed.
The halt on elective surgeries has formed one of the many strains on the post-acute care system amid the coronavirus pandemic; as seniors defer routine surgeries such as joint replacements, skilled nursing facilities that specialize in post-surgical care have seen a primary source of income dry up.
In many instances, providers rely on Medicare-funded post-acute patients to make up for the losses they incur caring for long-term residents covered by Medicaid, which in many states does not reimburse facilities for the full daily cost of those residents’ medical needs.
“Those are absolutely going to have significant effects on volumes for post-acute care providers,” Fred Bentley, managing director at consulting firm Avalere Health, said of the bans during a March 19 presentation.
That said, the resumption of surgeries — and the need for subsequent post-acute care for patients — would create its own set of challenges, as sending people directly from the hospital to a skilled nursing facility presents a significant and deadly opportunity for the spread of COVID-19.
The Sunday plan only applies to areas that have reached Phase I of the federal “Opening Up America Again” structure that the White House released last week. To even get to that point, states or regions must report a variety of positive COVID-19 reduction trends, including observing 14-day declines in both flu-like symptoms and COVID-19 cases — and having a “robust testing program in place for at-risk health care workers, including emerging antibody testing.”
The United States currently has the capacity to test just 45 out of every 100,000 people in the country every day, the New York Times reported last week. Experts told the publication that the figure has to reach 145 per 100,000 before officials can begin safely easing social distancing and other coronavirus-related restrictions.
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