Elective surgery volume near normal in late July, analysis finds

• Surgery volumes in July recovered to pre-COVID-19 levels.
• A growing number of states are re-imposing elective surgery bans.
• A surge in cases may lead to more bans in populous southern and western states.

Elective procedures returned to their January volumes by late July, despite a recent resurgence of COVID-19 cases that led to some voluntary and involuntary suspensions of such procedures, according to a national analysis.

By July 20, scheduled surgeries for about 1,500 surgeons reached about the same number that were scheduled in January, before the pandemic, according to data provided to HFMA by surgical scheduling company Surgimate.

“While we often hear that patients may be skeptical, keep in mind that there was a tremendous April and May backlog to work through,” Rebecca Brygel, CEO of Surgimate, a scheduling company for physician-owned practices, said in a written statement. “Either way, a good portion of patients who require surgical intervention are able to receive the care they need in most areas.”

Surgery cancellation and rescheduling rates fell from 88% in April to pre-COVID-type rates of about 28% in late July. Cancellation rates fell to 46% in May and 35% in June as states lifted bans on elective procedures.

The data reflected hospitals’ recovery trend. Operating room minutes jumped by 92% in May compared with April, although the metric remained 29% lower than in May 2019, according to the latest data from Kaufman Hall, covering more than 800 hospitals.

More recent data examined by Fitch Ratings showed hospital admissions and surgery volumes returned to 89% of pre-COVID levels in states that opened back up following the first wave, Kevin Holloran, a senior director, said in a July 16 call with investors.

“It was far more rapid than we expected,” Holloran said.

A similar volume recovery in elective surgeries was seen in some ambulatory surgery centers, Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), said in an interview.

Surgimate interpreted its data to mean that after restrictions were lifted following the first COVID-19 wave, surgeons’ volumes were not affected by new state requirements for extensive cleaning regimes before and between procedures.

But new infection-control measures are still limiting volumes at some ASCs, Prentice said.

“The difference is procedures are taking longer because of more screening, more intense infection control,” Prentice said. Some facilities have extended operating hours and added days to try to compensate.

The Surgimate data includes surgeons from recently hard-hit states, albeit fewer than in other states.

State bans start to mount again

Some southern and western states affected by the latest spike in COVID-19 cases have sought to reimpose elective surgery restrictions.

On July 9, Texas Gov. Greg Abbott banned elective procedures in hospitals in all counties located within 11 designated “trauma service areas.” Abbott ordered hospitals within those areas to postpone “all surgeries and procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician,” according to a preceding order on which the new ban was based.

On July 10, the Mississippi Department of Health issued an order that certain nonurgent surgeries and procedures be postponed.

On July 13, the New Mexico Department of Health issued a public health order that reimposed an April 30 public health order prohibiting nonessential healthcare services, procedures and surgeries.

Industry experts see reason for concern

“Like Texas is starting to pull the throttle back on elective procedures, it feels to me like it is almost inevitable that the other states are going to have to do the same thing,” Holloran said, referring to areas with a resurgence of COVID-19 cases.

Any effect on surgery volumes in those states could start to appear within the next few weeks.

“While the last 60 days have delivered sound surgical care, it is hard to forecast the future,” Brygel said. 

At this point, August scheduling looks similar to August 2019, Brygel said, even as the number of daily infections reported nationwide has doubled over the last 30 days. Daily new U.S. infections increased from 32,349 on June 22 to 69,641, o n July 24, according to one tracking site.

The new state restrictions don’t apply to ASCs, according to Prentice. But those facilities have been affected by shortages and increasing costs of personal protective equipment.

Holloran said if hospitals’ volumes drop again this year, those organizations will need to look at further cuts to expenses, especially personnel and supply costs.

“If the volume hits become more than temporary, which has been the view up until now, and they become more permanent, you’ll see further revenue reductions, you’ll see further expense reductions, and some of those may turn permanent, versus [employee] furlough,” Holloran said.