The White House and the Centers for Disease Control and Prevention (CDC) have recently unveiled a three-phase plan to “help state and local officials when reopening their economies, getting people back to work, and continuing to protect American lives.” States that satisfy gating criteria for symptoms, cases, and hospitals can commence phase 1 of the plan.
Presented in phase 1 of the plan, and of particular relevance to struggling hospitals and physicians, is the guideline which specifies, “elective surgeries can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines.” It is widely believed that the reinstatement of elective surgeries —hospitals’ main source of immediate income — may help hospitals make payroll, thus curtailing recent furloughs, pay cuts, and layoffs.
While practices like Vohra Wound Care Physicians’ have been delivering treatment via telemedicine for years, countless hospitals and physicians have been forced to remain involuntarily idle during the pandemic, due to the inability to deliver continuity of care via telehealth. The reinstatement of elective surgeries along with additional provisions brought forward in Phase 1 of the reopening plan is welcomed news for many healthcare providers across the US.
Telemedicine at Home
Texas, Oklahoma, and Alaska lift elective procedure restrictions
Some states have already begun phase 1 of the plan, and because the guidelines are not mandated, each state has been able to resume elective procedures based on the unique ways COVID-19 has impacted their states and the unique challenges that lie ahead.
Texas. On Friday, April 17, 2020, Texas Governor Greg Abbott issued three Executive Orders to begin the reopening of Texas. One of the executive orders loosened restrictions on surgeries put in place in March and provided two types of procedures that do not need to be postponed starting on Wednesday, April 22, 2020.
The first procedure laid out refers to “any procedures that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment (PPE) needed to cope with COVID-19.”
The second procedure refers to, “any surgeries or procedures performed in a licensed health care facility that has certified in writing to Texas HHSC both (1) that it will reserve at least 25% of its hospital capacity from the treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-19 patients, and (2) that it will not request any PPE from any public source—whether federal, state, or local—for the duration of the COVID-19 disaster.”
Oklahoma. By amending a previous Executive Order, Governor Kevin Stitt set guidelines for medical providers to determine which elective surgeries can resume on Friday, April 24, 2020. He also signed an Executive Memorandum that outlines an Elective Surgery Acuity Scale (ESAS) for providers to use when deciding when elective surgeries should be performed during the COVID-19 crisis.
In a local article, Oklahoma News 4 quotes Governor Stitt as saying, “we initially suspended elective surgeries to preserve hospital bed capacity and PPE to handle a potential surge in COVID-19 patients. Since our data indicate we are in a good position regarding hospital capacity – and provided individual institutions can accommodate their internal demand for PPE – it is time to bring some of these procedures back to help out hospitals and the Oklahomans who need them.”
Alaska. Governor Mike Dunleavy issued a mandate which allows for nonurgent elective procedures that cannot be delayed over 8 weeks to be resumed on Monday, May 4, 2020. The order also sets requirements that must be met for hospitals and ambulatory surgical facilities to start performing elective procedures.
Looking ahead to future phases
It is in the best interest of hospitals, physicians and patients to get off to a good start when resuming elective procedures, and meeting all 3 gating criteria is the first step.
Gating criteria 1 refers to “a downward trajectory of influenza type illnesses and COVID-like syndromic cases reported within a 14-day period.”
Gating criteria 2 consists of “a downward trajectory of documented cases and positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests).”
Gating criteria 3, which may be the most important in regards to the actual start of elective procedures, mandates that “hospitals have a robust testing program in place for at-risk health care workers, including emerging antibody testing.”
In a recent CNN article, Seema Verma, an administrator of the Centers for Medicare and Medicaid Services, alluded to the importance of gating criteria 3 when saying, “facilities must evaluate and prioritize what care should be given, screen staff and patients for symptoms, including temperature checks, and have sufficient personal protective equipment and other supplies on hand…. Also, when the adequate testing capability is established, patients should be tested before care and staff should be regularly screened by lab tests. And conditions should be continuously evaluated since these procedures have to halt if a surge in COVID-19 takes place.”
Without taking these types of measures, it will be all but impossible to gain momentum and work toward completely reopening the healthcare system and returning to normality.
The future is promising
Lifting restrictions on elective procedures is a promising sign for struggling hospitals and physicians. If it is done properly, hospitals will be on their way to more work and fewer furloughs, pay cuts, and layoffs. Texas, Oklahoma and Alaska are taking steps forward and are off to a seemingly good start. With a collective effort, we can reopen our healthcare system one phase at a time.
Opportunities for physicians looking to get creative during COVID-19
Some physicians have chosen to get creative during the COVID-19 crisis. Specialists with intensive care unit experience have moved to the front lines in the battle against COVID-19, family medicine physicians have quickly implemented telehealth and telemedicine components into their practices, and physicians from all specialties and backgrounds have joined practices, like Vohra Wound Care Physicians, which has well-established telehealth and telemedicine platforms.