- CMS on Wednesday night issued new recommendations urging hospitals to delay non-essential elective surgeries to be more prepared for COVID-19 patients. The guidance gives providers the final decision on what procedures to put off, taking into consideration urgency and available staff, personal protective equipment, ventilators and beds.
- The American Hospital Association called the move "an appropriate step" that provides a balanced approach. "As we make additional preparations, it’s important to recognize that the cancellation of elective procedures — which the medical community needs to be prepared to implement — should be determined at the local, community level in consultation with hospitals and the clinical recommendations of physicians and nurses," AHA CEO Rick Pollack said in a statement.
- Also Wednesday, the Senate passed and President Donald Trump signed a coronavirus relief package that includes a provider-requested 6.2 percentage point increase to the federal matching rate for Medicaid. AHA applauded the bill but warned "more needs to be urgently done."
The CMS move comes amid several measures aimed at improving access for patients with COVID-19 as well as those with other needs who don't want to risk infection by going to a doctor's office or hospital, including temporary Medicare coverage for all virtual visits, a major expansion for the program. That builds on a provision in the first coronavirus funding package from Congress that temporarily rolled back Medicare telehealth regulations on geography and site origination.
Trump declared the crisis a national emergency Friday, allowing states to apply for waivers to ease regulatory barriers that could impede a broader response. Florida was granted the first such waiver Tuesday and more are expected to follow soon.
But providers say these actions, while helpful, don't go far enough, especially as a potentially severe financial downturn looms as result of the outbreak.
New York-Presbyterian is estimating the financial hit to the system because of the outbreak will be between $350 million and $700 million. NYP had expected to log an operating income of $246 million. If those financial figures are accurate, the health system would then have operating losses between $104 million and $454 million.
AHA on Wednesday asked Congress for more direct financial assistance as hospitals face the continuing outbreak. The group requested a payroll tax credit to offset uncompensated care costs for treating coronavirus patients as well as legislation to prompt financial stimulus for needed construction during the crisis.
"We know that hospital resources will be stretched beyond capacity as a result of this epidemic. Legislation that recognizes and helps mitigate these additional costs is an essential component to maintaining hospital financial viability," AHA wrote in the letter to Congressional leaders.
America's Essential Hospitals asked Congress to suspend the 2% Medicare sequester payment reduction and increase the Medicaid disproportionate share hospital allotments by at least 3%. "Essential hospitals are spending money now to reorient clinical services and business functions in response to the major disruptions COVID-19 will cause to day-to-day operations," the group said in its letter.
MGMA, which represents large physician practices, called for some of the same actions as well as changes to the Physician Fee Schedule to help offset costs related to COVID-19.
Before the guidance from CMS on Wednesday, several major health systems had already moved to defer elective surgeries as they brace for an influx of coronavirus patients. On Sunday, U.S. Surgeon General Jerome Adams pushed for such measures, saying hospitals should preserve PPE, avoid exposing other patients and keep staff focused on outbreak response.
Hospitals pushed back on the idea of blanket mandates, but the CMS recommendation provided nuance based on the type of procedure, where it is performed and the health of the patient.
The guidelines break elective procedures down into three tiers. CMS recommends low-acuity services like a colonoscopy in an outpatient setting be postponed, but not transplants, neurosurgery or limb-threatening vascular surgery performed in a hospital. Procedures like hip and knee replacements fall into the "consider postponing" category.
But elective procedures are lucrative for hospitals. In its financial documents, NYP said the temporary suspension of those services would help with preparation for an increase in patients but "will have a negative effect" on 2020 revenue.
Hospitals are taking other measures in an attempt to limit further spread of the virus, including restrictions on visitors. Banner Health, a major health system in Arizona, severely restricted its visitor policy Wednesday.
Also this week, The Joint Commission said it is suspending all regular surveys. "In some cases, there may be a small number of surveys that will need to continue, such as high-risk situations. We will provide more details soon on what surveys are proceeding," the oversight organization said.