- Federal guidance for providers in Phase 2 of reopening includes a recommendation to evaluate local COVID-19 trends.
- Nearly 40% of the public plans to delay elective procedures over the next six months.
- One large physician group has developed a risk categorization system that it applies to each prospective elective surgery patient.
Federal officials built on earlier recommendations for providers by issuing another round of reopening guidance this week, as well as tips for patients who may be leery of returning to healthcare facilities.
CMS on June 9 issued the “Phase 2” recommendations to health systems. The guidelines followed the April 19 release of “Phase 1” reopening instructions.
The latest guidance, which applies only to providers in states and regions with no evidence of a coronavirus rebound — as set out in the Trump administration’s “gating criteria” — includes:
- Optimizing the use of telehealth to minimize the need for in-person services
- Evaluating the incidence of and trends related to COVID-19 in the community
- Evaluating the necessity of the care based on clinical needs
- Establishing sites where all patients can be screened for symptoms of COVID-19
- Ensuring protective equipment, clinical staff, facilities, other supplies and screening and testing are available in quantities that exceed the facility’s surge capacity
- Participating in a registry or national data collection system to track patient outcomes, facility and system impacts and resource allocation
The guidance for patients, which aims to alleviate concerns as well as to better inform them, includes:
- Not postponing necessary care, including preventive services
- Asking their healthcare provider about facilities and the precautions put in place to keep patients safe
- Considering telehealth or virtual visits
- Understanding the precautionary steps providers may ask them to take
Survey highlights patient concerns
“Americans need their healthcare and our healthcare heroes are working overtime to deliver it safely,” said Seema Verma, administrator of CMS. “Those needing operations, vaccinations, procedures, preventive care or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”
The challenge of realigning patients with providers amid efforts to restart elective procedures and other types of care was underscored in a recent survey by the Alliance of Community Health Plans (ACHP) and the Academy of Managed Care Pharmacy. Among respondents, 72% changed their use of healthcare services during the pandemic. Especially concerning were indications of patients’ plans for the coming six months, including:
- 38% planning to delay elective procedures
- 27% planning to delay diagnostic procedures or tests in a hospital setting
One provider’s approach to reopening
The Permanente Medical Group in Northern California is well into its restart of elective procedures. Those dropped to 40% of pre-pandemic levels at the peak of the outbreak and lockdown but are expected to return to full capacity by the end of June, said Smita Rouillard, MD, associate executive director.
One key has been the organization’s creation of a risk categorization system that it applies to each prospective elective surgery patient. That tool analyzes the relative risk of rescheduling surgery for patients based on their own characteristics (such as age and comorbidities), plus the relative risk of the surgery.
“Coupling those two together, we could then come up with a recommendation for the patient as to what their risk was,” Rouillard said in an interview.
The organization’s coronavirus testing of all asymptomatic patients scheduled for surgery thus far has found a lower incidence compared with the surrounding communities, she said.
Rouillard said the organization’s greatly expanded use of telehealth not only maintained close relationships between physicians and patients who needed surgery but also allowed for ongoing conversations to address patient fears about undergoing surgery. She credited physicians’ telehealth efforts with a very low incidence, about 2%, of patients who refused to return for needed surgery.
“Delivery was pretty consistent with how we were delivering care prior to COVID, so patients felt reassured by that,” Rouillard said.
