Coronavirus update: CMS offers guidance on elective surgeries and procedures

The Centers for Medicare and Medicaid Services (CMS) is advising physicians and healthcare facilities use a tiered framework to determine if an elective surgery should be performed.

The new guidance, released March 18, followed statements by the Trump administration’s Coronavirus Task Force Coordinator Deborah Birx, MD, urging doctors to postpone elective surgeries until the global pandemic is reined in due to the urgent need for medical supplies and fear of possible infection with the virus.

“Things that don’t need to be done over the next two weeks don’t get it done,” Birx said March 17 during a press conference at the White House. “If you’re a person with an elective surgery, don’t go into a hospital right now.”

CMS is providing the tiered framework to help physicians and healthcare make decisions on how best to allocate the resources they have, but the agency still urges that “[d]ecisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have direct responsibility to their patients.”

Factors that CMS believe should be taken into consideration when deciding whether a planned surgery should be performed as scheduled are:

• Current and projected COVID-19 cases in the facility and region

• Supply of personal protective equipment to the facilities in the system

• Staffing availability

• Bed availability, especially intensive care unit beds

• Ventilator availability

• Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery

• Urgency of the procedure

The framework provided by CMS has three tiers with a branch on each tier. Both branches of the first tier call for the postponement of the surgery or procedure. These are low acuity surgeries with healthy and unhealthy patients without life threatening illness at hospital outpatient departments, ambulatory surgery centers, or hospitals with low or no COVID-19 census. Examples include carpal tunnel release, colonoscopy, cataracts, and endoscopies.

The second tier’s first branch calls for the consideration of postponing intermediate acuity surgeries or procedures for healthy patients in hospital outpatient departments, ambulatory surgery centers, or hospitals with low or no COVID-19 census. Examples include low-risk cancer procedures, non-urgent spine and orthopedic procedures, stable ureteral colic, and elective angioplasty.

The second branch of the second tier call for postponement of surgery or procedure if possible for intermediate acuity surgery in unhealthy patients at hospital outpatient departments, ambulatory surgery centers, or hospitals with low or no COVID-19 census.

Both of the third tier branches call for high acuity surgeries in healthy and unhealthy patients at hospitals to not be postponed. Examples include cost cancers, neurosurgery, highly symptomatic patients, transplants, trauma, cardiac with symptoms, and limb-threatening vascular surgery.