CMS is urging all hospitals to comply with the American College of Surgeons' recommendation to cancel non-urgent elective procedures amid the COVID-19 pandemic.
However, some hospitals and health systems nationwide have opted to continue some surgeries based on their patients' needs.
Here's their thinking:
UC Davis Medical Center (Sacramento)
The major academic medical center cares for a large volume of patients with complex health conditions and surgical needs. The hospital said it is continuing to offer scheduled surgeries for select patients, as the hospital is not yet seeing any surges related to COVID-19. About half of the hospital's surgical cases for March 19 are oncology- or injury-related. A spokesperson for UC Davis said the hospital is evaluating surgical cases daily to determine which can be rescheduled.
"Although we are the largest hospital in the area, we are not encouraging surgeries, but we are saying to surgeons and their patients that we can accommodate patients' needs," the spokesperson told Becker's. "These surgeries, especially pain-relieving, trauma and cancer-related procedures, are not seen as 'elective' by patients. Moreover, we are able to make changes in less than 24 hours, should demands change."
Robert Szabo, MD, chair emeritus of hand, upper extremity and microvascular surgery in the orthopedic surgery department at UC Davis Health System
Dr. Szabo said surgeons doing elective procedures are only doing cases deemed "essential surgery," and when a patient expresses concern about moving forward with the procedure, the system reschedules the surgery without hesitation.
"Some [patients] have been waiting for surgery and are in a fair amount of distress and are grateful that we are willing to go ahead and treat them. They are informed of and claim to understand the risks involved," said Dr. Szabo. "This is a day-by-day decision that may change at any time, particularly if we see that there is a need for resources."
Robert Masson, MD, founder and medical director of Masson Spine Institute in Orlando, Fla.
Dr. Masson continues to perform cases at the NeuroSpine Center of Excellence at Orlando Health Central Hospital, limiting visitors to one per patient.
"Most of my patients have severe neurological symptoms and pain and are pleading with us to stay open," said Dr. Masson. "I personally only see advanced-level spine problems, whether they need a decompression only or a decompression reconstruction. This service policy that we are trying to maintain affects only those with severe functional consequences. Anybody with a routine, nonsurgical problem, we are not treating at this time."
Hilton Head (S.C.) Regional Healthcare
Hilton Head Regional Healthcare has developed guidelines for elective care based on guidance from authorities, the health system said in a statement emailed to Becker’s. The system is rescheduling cases for any patients in which the delay will not adversely affect their health, but plans to proceed with all "emergent and urgent procedures and diagnostics," Hilton Head Regional Healthcare said.
"We seek to balance the needs for care for those with chronic or other illnesses that require healthcare diagnostics or procedures and where delaying it could cause them to require emergency care a few weeks from now, at a time when COVID-19 cases might be ramping up," the statement reads.
UPMC (Pittsburgh)
Unlike hospitals seeing large volumes of COVID-19 patients on the East and West Coast, UPMC is at an earlier point on the curve, according to Steven D. Shapiro, MD, the system's executive vice president, and chief medical and scientific officer. UPMC has seen a few COVID-19-related admissions and is monitoring the situation through daily deidentified testing.
Instead of using "elective" as a blanket term for nonemergent surgeries, UPMC is encouraging surgeons to look at individual surgical cases with a more nuanced approach in terms of patient needs and procedure safety.
"We don't want to abandon our patients during these times. If they would be harmed by not doing surgery, we try to do it under as safe a condition as possible," Dr. Shapiro said. "To date, we are able to do that. This may change at any minute, so we are testing for COVID-19 pretty broadly so we are not blind to the situation."
Editor's note: This article was updated March 19 at 3:15 p.m. CDT.
More articles on patient flow:
In line with CMS' urging, more hospitals cancel elective surgeries
Are hospitals in your city ready for a surge of COVID-19 patients? A look at 4 scenarios
How one California hospital improved care delivery without burdening staff
Editor's note: Becker's is in communication with other providers that have decided not to postpone surgeries and will update the article accordingly.