CMS Issues Guidance on Resuming Elective Services in Certain Areas

As COVID-19 outbreaks start to wane in certain areas, CMS is releasing guidance on resuming non-emergent, elective services to non-coronavirus patients without symptoms.

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The guidance updates earlier recommendations from CMS on canceling or postponing non-essential surgeries and medical procedures. The new guidelines provided by CMS on April 19 advise a gradual transition to normal operations for providers in communities starting to see a decline in COVID-19 cases.

“Today, some areas of the country are experiencing fewer cases and lower incidence of the virus, necessitating a more tailored and flexible approach,” CMS Administrator Seema Verma stated in an announcement. “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.”

The new guidelines provided by CMS are part of the Trump administration’s recommendations for opening up the economy after COVID-19. The latest recommendations are part of Phase 1 of the administration’s Guidelines for Opening Up America Again.

Guidelines for Opening Up America Again is a three-phased approach for reopening economies that have been shut down due to COVID-19.

In Phase 1, states and regions can start to lift restrictions if the number of documented COVID-19 cases within a 14-day period declines or the percentage of positive COVID-19 tests as a percent of total tests falls within a 14-day period.

In order to qualify for Phase 1 of the recommendations, states or regions must also have a downward trajectory of influenza-like illnesses within a 14-day period and a downward trajectory of COVID-like syndromic cases reported within a 14-day period. Hospitals must also treat all patients without crisis care and have robust testing programs for at-risk healthcare workers. The testing programs should include emerging antibody testing.

According to the guidelines, states and regions that pass the gating criteria can resume elective surgeries, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines.

But healthcare organizations in Phase 1 states and regions should coordinate with local and state public health officials before restarting elective services, CMS stated in the guidance.

Organizations should also review availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity before restarting or increasing in-person care, the agency stated.

However, organizations in Phase 1 communities should continue to screen all patients for COVID-19 symptoms and be prepared to cease operations if a surge in coronavirus cases occurs, CMS stressed in the guidelines.

“We welcome and support today’s guidance from the CMS,” the American Hospital Association’s president and CEO Rick Pollack said in a statement on 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,” he stated. “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.”

Healthcare organizations have adhered to CMS’ previous recommendations to cease all non-essential procedures and services to stop the spread of COVID-19. But the decision has harmed certain providers.

On average, physician practice revenue has declined by 55 percent since the start of the COVID-19 outbreak, according to a new report from the Medical Group Management Association (MGMA). A majority of independent medical groups also anticipate depleting their cash reserves within the next two months, AMGA also reported.

“By complying with our recommendations to postpone non-essential elective surgeries, our healthcare system has made a tremendous sacrifice,” CMS Administrator Verma stated. “We owe both those on the frontlines and those who postponed procedures for the sake of their colleagues a profound debt of gratitude.”