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COVID-19 may already be putting a dent in procedure volumes. Almost a quarter of doctors surveyed by a major investment bank said they're seeing an uptick in procedure cancellations or deferrals.
It's a small survey of 62 orthopedic surgeons, interventional cardiologists and anesthesiologists, but Jefferies analysts say the 23% who noted a change is enough to show that the novel coronavirus is prompting patients to reconsider going under the knife.
"They're relatively modest at this point," said David Steinberg, an equity analyst with Jefferies who co-authorized the report. "But if you see what they're saying about the future, more thought they'd see more cancellations and referrals."
As the number of U.S. coronavirus cases rise, 55% of respondents said they expect deferrals and cancellations to increase. And 55% said their institutions have started to prepare for possible deferment of procedures or a reallocation of resources as a result of the coronavirus.
So far, the cancellations have been minor, affecting 16% of volumes on average, with doctors noting a range between 5% and 30%.
Interventional cardiologists were most likely to report changes in procedures already, with 29% reporting cancellations or postponements in the past two weeks. That's compared with 23% among orthopedic surgeons, and 13% among anesthesiologists.
Steinberg said that finding surprised him because patients often have no choice when it comes to cardiology procedures, whereas orthopedic procedures tend to be more elective.
Dr. Marc Moon, a cardiac surgeon at Barnes-Jewish Hospital in St. Louis, said he hasn't seen a decrease in scheduled surgeries.
"Most people are coming in for heart surgery and they're in pretty bad shape so they don't want to delay and wait," he said.
Moon said he thinks it's premature to cancel procedures right now. He said there is little evidence that patients are more likely to be infected inside a hospital than outside one.
In their written comments, doctors noted that high risk or elderly patients were the ones canceling, as were patients getting knee replacements and other procedures that require general anesthesia.
Not surprisingly, Jefferies noted that doctors who are seeing impacts are in "front line" states like California, Massachusetts, New York, Texas and Washington.
The cancellations could be a boon to insurers, who would otherwise have to pay for the expensive orthopedic and cardiac procedures, which typically require inpatient admission, Jefferies said.
Anecdotal evidence suggests elderly patients, who are at highest risk of COVID-19 complications, are the ones canceling their procedures, the report noted, so big Medicare Advantage providers like Humana, UnitedHealthcare and Centene Corp. could stand to benefit.
"These indications suggest a disproportionate benefit for Medicare Advantage," the analysts wrote.
It's unclear whether such a benefit would outweigh the cost of covering patients' out-of-pocket costs for COVID-19 tests, as several insurers have pledged to do.
It's not uncommon for patients who delay scheduled surgeries in the winter months because they come down with respiratory illnesses such as the flu, Saum Sutaria, Tenet Healthcare's chief operating officer, said Wednesday at the Barclays Global Healthcare Conference, which was held virtually.
"But here, it's the fear of contagion that I think is more of the issue," he said, "and we'll see how that plays out. It's too early to tell what effect that will have, and whether that effect will be even remotely similar across different facilities in the U.S."
If the COVID-19 outbreak worsens in the U.S., it could be the hospital, not the patient, that cancels elective procedures. Dr. Tom Balcezak, the chief medical officer of Yale New Haven Health, told Modern Healthcare such a move wouldn't be the academic health system's first choice, but it would delay elective surgeries—especially cardiac and neurological, which require post-operative ICU care—if it needed more ICU capacity.
For its part, Yale New Haven Health is actively preparing for COVID-19 patients as the number of cases in neighboring New York and Massachusetts rise. Connecticut saw its first case of the coronavirus on March 8. The system activated its incident command structure across its seven campuses and five hospitals, which gives leadership more authority than usual to use financial and human resources, Balcezak said.
Yale New Haven is assessing whether it has adequate amounts of personal protective equipment and other supplies and has called in additional staff. Luckily, Balcezak said the system still has a number of traveling nurses on board from the winter flu surge. Yale New Haven also set up a call center for employees, medical staff and the public that's operating out of a newly created command center.
Balcezak said Yale New Haven is learning as much as it can from China, South Korea and Italy.
"The healthcare systems in those countries are not exactly akin to ours, but we're seeing a lot of the information that's coming out and we are doing all kinds of efforts around preparedness," he said.
