CMS urges delay of non-essential medical, surgical procedures during COVID-19 pandemic
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CMS announced all elective surgeries, non-essential medical, surgical and dental procedures should be delayed to preserve personal protective equipment, beds and ventilators during the COVID-19 outbreak.
“The reality is clear and the stakes are high: We need to preserve personal protective equipment for those on the front lines of this fight,” CMS Administrator Seema Verma said in a press release.
Not only will delaying non-essential medical, surgical and dental procedures preserve equipment, but it will also free up the health care workforce to care for patients who are most in need, according to CMS.
CMS also provided a tiered framework as health systems consider resources and how best to provide surgical services and procedures to patients with conditions that require emergent or urgent attention to save a life, preserve organ function and avoid further harms from an underlying condition or disease. CMS noted that when analyzing the risks and benefits of any planned procedure, local health care delivery systems must evaluate the clinical situation and consider resource conservation even in areas that are not currently dealing with COVID-19 infections.
During case-by-case evaluations, CMS suggests health care systems and physicians consider the following factors as to whether planned surgery should proceed:
- current and projected COVID-19 cases in the facility and region;
- supply of personal protective equipment to the facilities in the system;
- staffing availability;
- bed availability, especially ICU beds;
- ventilator availability;
- health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery; and
- urgency of the procedure.
CMS noted that the recommendations are meant to be refined in the duration of the crisis based on feedback from subject matter experts. In addition, health care providers should continue to encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus, as well as to follow current guidelines to help slow the spread of the virus.
In a statement, Patrice A. Harris, MD, MA, president of the AMA, noted the guidance provided by CMS on adult elective surgery “is a vital step i[n] allocating resources during the pandemic” as hospitals and physician practices plan for anticipated surges of patients needing care for COVID-19 infections by developing allocation policies that are fair and safeguard the welfare of patients.
“The CMS guidance offers needed flexibility to physicians by allowing them to consider the imperative of resource conservation, especially personal protective equipment,” Harris said. “The nation’s physicians know challenging days are coming. We are preparing for it and are grateful that the federal government understands that physicians need to have flexibility when responding to this threat.”
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Perspective
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John D. Kelly IV, MD
The recent CMS recommendations to delay adult elective surgeries in light of the recent COVID-19 pandemic is simply good medicine.
First, lower surgical volume will materially slow down person-to-person contact in hospitals, known to be epicenters of disease transmission. COVID-19 is considerably more contagious and virulent than influenza. Since viral transmission increases logarithmically, even a small decrease in person-to-person and person-to-“contaminated” objects contact in surgical facilities will result in substantive decrease in viral burden.
Secondly, it has been estimated that respirator needs, secondary to COVID-19 pulmonary compromise, may outnumber current availability five-fold. Thus, it is incumbent for hospitals to free up as many critical care resources as possible. Some elective surgeries (spine, large reconstructive) do often require intensive care support postoperatively and should be minimized to the greatest extent possible.
It is time we all do our duty to act for the common good. Indeed, delaying surgery is a bitter pill to swallow. However, the wellbeing (and lives) of many are at stake.
University of Pennsylvania
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