With the White House plan for Opening America Up Again, released April 17, 2020, states across the country are aiming to return to pre-pandemic healthcare, including elective surgeries and routine medical visits.

On April 19, 2020 the Centers for Medicare & Medicaid Services (CMS) released specific guidance for health systems on when and how to resume elective procedures that have been on pause due to the COVID-19 outbreak. CMS recognized that many areas have a low, or relatively low and stable incidence of COVID-19, and that it is important to restart care that is currently being postponed, such as certain procedural care (surgeries and other procedures), chronic disease care, and ultimately, preventive care.

This announcement comes after healthcare organizations across the country have gone weeks without scheduling non-emergency or elective healthcare treatments or procedures. Preventive care visits, chronic disease management and elective surgeries have been postponed to free up both physical space and clinical workforce in preparation for surge care access during the pandemic. 

CMS recommends a gradual transition based on states or regions passing the Gating Criteria to proceed to Phase 1. For healthcare facilities this includes the following:

  • Evaluate the trends for COVID-19 in the area to confirm a lower and stable incidence rate.
  • Consider establishing Non-COVID Care (NCC) zones to screen all patients for symptoms. Take measures to ensure these zones are separate from COVID treatment areas.
  • Ensure adequate testing capability to test every patient before procedural care.
  • Provide sufficient resources for expanded treatment including PPE, workforce, supplies, testing capacity and facilities without jeopardizing surge capacity.
  • Enforce guidelines requiring staff to wear surgical facemasks at all times and patients to wear protective face covering.
  • Facilitate social distancing—minimize time in waiting areas, space chairs six feet apart and maintain low patient volumes. Visitors should be prohibited.
  • Continue to evaluate the region’s capacity to remain low risk and be prepared to cease non-essential procedures if there is a surge.

Full details of the CMS guidance can be found here

As the U.S. takes steps to reopen society, states are taking the lead on specifics of what can reopen and when, according to a recent post by Becker’s Hospital Review. While some states have announced plans to gradually lift restrictions, others are considering whether they meet the Gating Criteria to begin Phase 1 for healthcare providers. Two key issues are holding the other states back: insufficient statistics to support stable or down-trending infections and the lack of testing kits.

As more states and regions satisfy the Gating Criteria to start Phase 1, and as early Phase 1 regions qualify to move to Phase 2, we can expect a steady rise in patient visits to address previously postponed care. A recent eHealth survey of 33 payers revealed that 80% of those surveyed expect an influx of non-urgent claims as more patients are permitted to access care safely.

Financial services firm Canaccord Genuity surveyed 50 orthopedic and spine surgeons to assess COVID-19’s impact on treatment and practice viability. Respondents predict a dramatic rise in future procedure volume with “41% expecting to catch up on procedure volumes within three months and another 35% within six months.” 

“Now that we are starting to see a number of markets peak, what will it mean?” Christopher Kerns, vice president of executive insights at the Advisory Board research firm, asked during an April 16 web conference. “When we think of volume recovery, a lot of attention has been paid to the amount of elective volumes or nonelective volumes that have been forgone during this period. In the long term, utilization will increase as the availability of therapeutics and vaccines reduces the likelihood of a second COVID-19 wave.”

Reopening and Recovery—the path forward

During this critical time of transition, HIM professionals offer the experience, expertise and leadership ability to help guide their organizations through the challenges that lie ahead. Clinical, financial and HIM teams must come together to ensure understanding and implementation of new regulations and coding guidance related to COVID-19. The healthcare industry has experienced crises in the past and we will recover from the COVID pandemic, armed with valuable insights and courage to navigate the path ahead.