Health care systems in the Triad and nationwide could soon resume doing elective surgeries.

The federal Centers for Medicare and Medicaid Services is preparing final guidance on resuming those surgical procedures in phases “in regions with low and stable incidence of COVID-19.”

The guidance is focused on allowing nonessential elective surgeries for patients without COVID-19 symptoms.

It is not clear if CMS guidance refers to regions of the country or regions of a state. Cooper administration officials said Tuesday that North Carolina as a whole does not yet fit into that low and stable incidence category.

Cone Health, Novant Health Inc. and Wake Forest Baptist Medical Center are more than four weeks into taking self-imposed revenue blows after agreeing to halt most non-essential elective surgeries to free up hospital beds, surgical rooms and intensive-care units for a potential surge of patients with coronavirus.

The systems included as non-essential appointments services, such as physical and well-checkups, as well as mammograms. Novant said its postponement of non-essential surgeries would last through April 30.

“By complying with our recommendations to postpone non-essential elective surgeries, our healthcare system has made a tremendous sacrifice, CMS administrator Seema Verma said in a statement.

“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 CMS guidelines recommend a gradual transition and encourage health care providers to coordinate with local and state public health and elected officials.

Factors include: review the availability of personal protective equipment and other supplies; workforce availability; facility readiness; and testing capacity.

“Prior to entering Phase 1, states or regions need to pass gating criteria regarding symptoms, cases and hospitals,” CMS said.

The N.C. Healthcare Association said in a statement that “our members welcome the new guidance from CMS on restarting elective procedures for non-COVID-19 patients.”

“Like other sectors of the economy, they are eager to resume many of those procedures in a safe and efficient manner. We agree that such decisions are best made by hospitals and their clinicians in collaboration with local and state governments.”

The association has formed a task force with N.C. Medical Society “to develop recommended principles.” The groups project making a presentation this week.

The Triad has been spared — so far — from material job losses, layoffs and furloughs from its three major health-care systems.

Moody Financial Services has projected that postponed elective surgeries “will likely reduce hospital revenue by 25% to 40% per month on average and strain cash flow significantly.”

The association said that based on March alone, N.C. hospitals combined have:

  • Foregone $800 million in revenues for elective procedures;
  • Added $135 million in excess supply and labor costs per month; and
  • Absorbed $82 million in expenses to protect health care workers and patients.

NCHA spokeswoman Cynthia Charles said the advocacy group has been communicating the financial data with state legislators as part of planting the seeds for state assistance.

“Virtually all hospitals expect to have negative cash flows this month,” Charles said. “The current situation cannot be sustained.”



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