Providers re-examine offering elective surgeries as COVID-19 cases surge

Providers and the associations that represent them are advocating for a case-by-case approach to rolling back non-urgent procedures in areas that are experiencing COVID-19 surges rather than reinstating a national decree.

Some hospitals in Arizona, Florida and other states that are seeing spikes in COVID-19-related hospitalizations are scaling back their services again to free up capacity. Others are taking a wait-and-see approach. 

Either way, most would prefer a more piecemeal process to rolling back elective procedures, rather than CMS reinstating a national executive order similar to the one that prohibited elective procedures from late March through April.

“When the initial guidance came out, and when many states shut down hospital scheduled services, one of the major concerns was PPE supplies and prep for surges,” said Chip Kahn, CEO of the Federation of American Hospitals. “I think we’re in a position today where we don’t need these broad-based shutdowns because we have a handle on those issues.” Individual health systems or communities should decide what elective procedures to move forward with based on their caseloads and local conditions, he said.

But not all providers agree with that assessment.

Nearly two-thirds of health system executives surveyed last month said canceling elective procedures would not be the right move amid future COVID-19 surges given the progress that’s been made, according to an Advis poll.

“How we did this—unilaterally shutting down elective surgeries across the country—made no sense,” Advis CEO Lyndean Brick told Modern Healthcare in June. “We need a much more informed approach to this.”

Responses to spikes in COVID-19 cases across the country have varied by organization as doctors and administrators weigh the impact of delayed care—particularly for those with serious conditions like heart issues and cancer—and steep revenue losses versus strict containment efforts.

Some hospitals in hard-hit states like Florida, where only around 15% of adult intensive-care units are available, are halting most non-urgent surgeries to ensure they can safely and quickly expand capacity as COVID cases increase daily. HCA Healthcare, for instance, is scaling back elective procedures across its hospital network in the state. Although it is still moving forward with elective procedures at hospital-owned outpatient departments and ambulatory surgery centers.

Cleveland Clinic said it has a plan in place to increase bed capacity at its Florida hospitals but did not detail its elective procedure strategy.

Phoenix-based Banner Health, which is housing around half of the entire state’s inpatient hospitalizations, is postponing any non-emergent procedures that require more than a four-hour stay in the post-anesthesia care unit.

The concern “is not so much around personal protective equipment, but that we have adequate capacity and staffing to care for those patients that need an inpatient stay,” said Dr. Marjorie Bessel, chief clinical officer at Banner.

Our Lady of the Lake in Baton Rouge, La., is continuing surgeries, said Dr. Catherine O’Neal, chief medical officer at the not-for-profit healthcare ministry and an infectious disease specialist. 

The system initially stopped operating on patients because little was known about the disease and the limited PPE supply. But it is trying to not repeat that because it “harmed a lot of people,” O’Neal said.