CMS Issues New Guidelines for Resuming Non-Emergency Surgeries as COVID-19 Restrictions Ease

The federal government on Tuesday unveiled a new set of guidelines for the safe resumption of non-emergency health care services, including surgeries and other inpatient procedures.

The Centers for Medicare & Medicaid Services (CMS) released the updated recommendations as many states have begun tentatively lifting the strict stay-at-home orders that had been in place since the middle of March.

The agency framed the announcement, which also included a separate set of safety tips for patients, as the Trump administration encouraging the re-opening of health care facilities.

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“Americans need their health care and our healthcare heroes are working overtime to deliver it safely,” CMS administrator Seema Verma said in a statement. “Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”

The guidelines only apply to states or regions that have entered the second phase of the federal government’s multi-step re-opening plan, largely achieved by observing no significant rebound in COVID-19 cases after clearing the first stage. Earlier guidance for resuming non-essential surgeries, released in April, only applied to the first phase.

Under the June recommendations, CMS calls for “non-emergent, non-COVID care” (NCC) to be performed only in facilities that have adequate testing capacity, stockpiles of personal protective equipment (PPE), and proper staffing to combat a potential outbreak, as well as the ability to safely separate COVID-19 patients from those without the virus.

Surgeries and other procedures must still be limited only to those that would “likely result in patient harm” if deferred any longer. At-risk populations, such as those with underlying health conditions and those without access to telehealth services, will also be prioritized.

“Some patients have been delaying care for chest pains, stroke symptoms, or other signs and symptoms of potentially serious health conditions,” CMS advised in its guidelines for patients. “Do NOT postpone care that is urgent or may lead to complications such as heart attack or stroke.”

For high-risk populations such as nursing home residents and anyone over the age of 65, CMS deferred to Centers for Disease Control & Prevention (CDC) guidelines calling for a detailed care plan and limiting surgeries “as much as clinically possible.”

CMS and other government agencies have suspended most reimbursement and technical rules around telehealth in an attempt to expand access to remote care during the peak of the pandemic, though even some leaders in the field have acknowledged that access to face-to-face care remains vital.

Verma echoed those sentiments in the Tuesday statement.

“But while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” Verma said statement.

The suspension of non-emergency surgeries took a significant financial and operational toll on skilled nursing facilities that specialize in Medicare-reimbursed post-acute care — at a time when their long-term care population found itself under direct attack from the novel coronavirus.

The near-complete cessation of new admissions from the hospital during the earliest days of the crisis, when federal and state health authorities moved to reserve hospital capacity for a predicted wave of COVID-19 cases, in part contributed to a precipitous drop in skilled nursing census nationwide.

While that spike in coronavirus cases did occur in many regions, it never arrived in others.

In Texas, which avoided the first swell of COVID-19 cases that hit hospitals in places like New York and New Jersey, Bridgemoor Transitional Care president Mark Fritz described working with health systems to develop COVID-19 overflow contingency plans that were never needed.

Though a lack of a COVID-19 crisis was obviously a positive outcome for the community, the suspension of surgeries threw a temporary wrench into Bridgemoor’s operational plan.

“Financially, there’s been much better days than what we’re going through right now,” Fritz told SNN in April.

That said, operators and investors have been upbeat that the return of elective surgeries and subsequent demand for post-acute care — already an area with clinical and financial upsides under the new Patient-Driven Payment Model (PDPM) — will help spur some move toward normalcy in a battered landscape.

“We think that skilled has a really strong future,” Sabra Health Care REIT (Nasdaq: SBRA) CEO Rick Matros said. “We already started seeing some demographic benefit. You have PDPM. You have a decline in supply with an increase in demand. So all those things converge to make a long run.”

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