CMS releases guidance for how health systems can restart elective procedures canceled due to COVID-19

The Trump administration has released new guidance for health systems on when and how to resume elective procedures that have been on pause due to the COVID-19 outbreak.  

The Centers for Medicare & Medicaid Services recommends a gradual transition based on testing capacity, workforce availability and readiness.

“Healthcare officials must ensure they can handle any surges. They have a plan to conserve supplies and screen healthcare workers for coronavirus,” CMS Administrator Seema  Verma said during a call with reporters on Monday.

The guidance, released late Sunday, comes as facilities face financial strain due to a loss of revenue from the cancellation of elective procedures. The lack of revenue from such surgeries, in addition to low patient volume overall, has sparked a cash crisis for U.S. hospitals. Some major healthcare systems such as Tenet, Trinity Health and Detroit Medical Center have had to furlough workers due to the lack of cash.

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The agency cautioned that any decision to resume procedures will be up to local and state authorities. The guidance said that staff should also be routinely screened for COVID-19 and tested and quarantined. It also calls for staffing levels to “remain adequate to cover a potential surge in COVID-19 cases.”

A facility that decides to reopen procedures should also create areas to reduce the risk and exposure to COVID-19. Any patient who is coming in for a procedure must also be screened for potential symptoms of COVID-19.

“When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well,” the guidance added.

CMS' guidance also said that facilities need to:

  • Establish a plan for thorough cleaning and disinfection prior to using spaces for patients with non-COVID-19 cases;
  • Prohibit visitors except if they are necessary for some aspect of patient care;
  • Facilitate social distancing by minimizing wait times, spacing chairs at least six feet apart and keep low patient volume; and
  • Require patients to wear a cloth face covering that can be bought or made at home if they don’t already have a surgical mask.

While the guidance offers some additional clarity to health systems developing plans to restart at least some elective surgeries, it appeared to fall short of some of the recommendations offered by provider groups last week.

For instance, a roadmap released by groups such as the American Hospital Association and American College of Surgeons also called for hospitals to show a steady two-week decline in COVID-19 cases and ensure they have enough protective equipment and staff to handle both COVID-19 cases and care for other patients before they resumed procedures. 

Hospital groups praised the guidance. 

"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," said Rick Pollack, president and CEO of the AHA, in a statement Sunday. 

Three states—Texas, Oklahoma and Alaska—have issued their own plans for restarting elective procedures.

Texas Gov. Greg Abbott issued an order that loosens restrictions on surgeries that would not be expected to deplete hospital capacity or personal protective equipment (PPE) needed to cope with COVID-19. Further, the order called for any facility performing those procedures to certify they will reserve at least 25% of hospital capacity for COVID-19 patients and will not request PPE from any public source for the duration of the crisis.

Oklahoma's governor also signed a similar order saying individual institutions that can accommodate their internal demand for PPE could resume elective surgeries later this month.