CMS releases guidance on resuming patient care in areas with low incidence of COVID-19
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As part of phase 1 of the Trump administration’s guidelines for re-opening America, CMS issued guidance on providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with a low and stable incidence of COVID-19.
The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures by recommending a gradual transition and encouraging health care providers to coordinate with local and state public health officials, according to a press release. The guidelines also recommend health care providers review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness and testing capacity when making the decision to re-start or increase in-person care.
Decisions for resuming elective surgery
However, the release noted these recommendations are not meant to be implemented by every state, county or city at this time. Governors and local leaders need to make decisions on whether the recommendations are appropriate for their communities, with states or regions required to pass gating criteria regarding symptoms, cases and hospitals, according to the release. CMS encouraged health care facilities and providers in areas with a higher number of COVID-19 cases to continue following the recommendations made to expand capacity to care for patients with COVID-19, to reduce the risks of transmission and exposure to patients and to conserve adequate supplies, especially PPE and manpower, during the public health emergency. CMS also encouraged providers and patients to use virtual care for services that can be managed through remote appointments as a way to continue limiting the risk of exposure and spread of COVID-19.
“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 frontlines and those who postponed procedures for the sake of their colleagues a profound debt of gratitude,” CMS Administrator Seema Verma said in the release. “Today, some areas of the country are experiencing fewer cases and lower incidence of the virus, necessitating a more tailored and flexible approach. Every state and local official will need to assess the situation on the ground to determine the best course forward, but these guidelines provide a gradual process for restarting non-COVID-19 essential care while keeping patients safe.”
Additional joint guidance
In addition to the recommendations provided by the CMS, the American Hospital Association (AHA), in partnership with the American College of Surgeons, the American Society of Anesthesiologists and the Association of periOperative Registered Nurses, developed a roadmap to guide physicians, nurses and local facilities in readiness, prioritization and scheduling to ensure patients can have elective surgeries as soon as safely possible.
According to the guidance document, prior to resuming elective surgical cases, the rate of new COVID-19 cases should have a sustained reduction in the relevant geographic area for at least 14 days. Facilities should also have an appropriate number of ICU and non-ICU beds, PPE, ventilators and trained staff to treat all non-elective patients without resorting to a crisis standard of care. The document noted available testing should be used to protect staff and patients whenever possible, with facilities implementing a policy addressing requirements and frequency for patient and staff testing.
Adequate PPE and medical surgical supplies appropriate to the number and type of procedures to be performed should be acquired prior to resuming surgical procedures, the document noted. The document also noted surgery, anesthesia and nursing leadership should be used to establish a prioritization policy committee to develop a prioritization strategy appropriate to the immediate patient needs.
Policies addressing care issues specific to COVID-19 and the postponement of surgical scheduling should also be adopted by facilities, and policies and procedures should be frequently re-evaluated and re-assessed based on COVID-19 related data, resources and testing, as well as other clinical information, according to the document. Finally, the document noted a social-distancing policy should be developed and implemented by facilities for staff, patients and patient visitors in non-restricted areas in the facility that meets the then-current local and national recommendations for community isolation practices.
“We welcome and support today’s guidance from the CMS, which complements the work that the AHA has been doing with other partners in the health field, including the American College of Surgeons, the American Society of Anesthesiologists and the Association of periOperative Registered Nurses,” Rick Pollack, president and CEO of the AHA, said in a statement. “This CMS guidance is clearly focused on addressing important health care needs for non-COVID patients, with decisions being made by providers in collaboration with local and state public health leaders. CMS also rightly expects hospitals and health systems to maintain the flexibility needed to quickly respond to a surge should one occur in their community, and to maintain separate caregivers and locations within a facility for non-COVID care.”
References:
www.aha.org/press-releases/2020-04-20-aha-statement-cms-guidance-elective-procedures
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