Is This Procedure Essential? Rationing Care During the Coronavirus

With hospital beds, ventilators, healthcare providers, and personal protective equipment (PPE) in short supply across the country, many states have signed executive orders limiting all elective or non-essential medical procedures, so healthcare providers can focus their energy on treating those infected with the virus. As a result, thousands of patients are now having to postpone various procedures and appointments until the pandemic is under control.

However, determining which patients and procedures are essential isn’t always clear. In some cases, postponing a check-up or medical procedure can worsen patient outcomes. Healthcare providers in some of the worst-hit areas of the pandemic now find themselves having to make complex life-or-death decisions as they respond to both COVID-19 patients and those being treated for other reasons.

As a healthcare provider, if you are asked to ration care and medical services during the pandemic, learn more about this thorny issue and discover some resources to help limit non-essential care at your facility.

New Recommendations for Postponing Non-Essential Care

Several federal and medical organizations have recently issued recommendations regarding postponing elective procedures to help public and private facilities make sense of this trying time.

The Centers for Medicare & Medicaid Services (CMS) recently announced that all non-essential adult surgeries and procedures, including dental, must be postponed during the coronavirus pandemic. Sending these patients home or rescheduling these appointments and procedures will not only help preserve crucial supplies, but it will also limit their potential exposure to the virus.

Which Procedures are “Non-Essential”?

Click here to read the full CMS recommendations for sorting out what to postpone and what not to postpone during the pandemic. The included chart organizes patients according to the severity of their healthcare needs to help providers quickly make determinations.

As an example, the chart reveals that patients suffering from cataracts or those who need colonoscopies will likely have to wait, while those suffering from cancer, transplant patients, and highly symptomatic patients will likely need care right away.

Tips on Limiting Non-Essential Care

The Center for Disease Control and Prevention has released guidelines for reducing non-essential care during the pandemic. The organization has come out with several tips that should help you limit elective and non-urgent medical services during this time:

• Instruct patients to call in advance of their appointments if they have symptoms of any illness for clinical advice.
• Review rescheduling and/or cancellation policies to ensure they are aligned with CDC and CMS guidance.
• Utilize a recorded message when possible advising patients how to self-screen.
• Use the same recorded message to advise those who have recently traveled to self-quarantine as recommended by the CDC and/or their state or local department of health.
• Discuss the need to reschedule a planned appointment or to be seen in a different setting, e.g. via telemedicine visit, with patients.
• Define a common language for staff to use when speaking to patients; enforcing the CDC guidance is necessary, but should not arouse panic. Consider individual patient needs in the context of your practice’s and community’s capacity.
• Expand prescription medication refills to a 90-day supply when appropriate and consistent with their clinical status. They should contact their pharmacy to ensure medications can be filled.
• Encourage patients to contact their insurance plans if refills are not initially approved. Several insurance companies have pledged to waive prescription refill limits on maintenance medications.

Every staff member at your facility should be familiar with these guidelines as you and your team continue fielding requests and questions regarding non-essential care.

Blurred Lines 

As helpful as these guidelines might be, some patients are bound to blur the lines between essential and elective. We’ve heard from several nurses and care providers on the front lines of the pandemic who say that carrying out these new recommendations can be difficult and emotionally draining.

A surgeon at Columbia University in New York City recently spoke to CNN about his experiences with rationing care. His team has had to figure out what to do with dozens of other patients who still need his services, including “shunt-dependent infants, children with ventricular septal defects in heart failure, teenagers with bad valves.” In some cases, postponing care could lead to devastating patient outcomes, even if the procedure isn’t deemed “essential.” Providers should assess the risk factors associated with postponing care to avoid certain worst-case scenarios.

One patient started noticing her own irregular heartbeat, so she scheduled two appointments for April to have tests performed on her pacemaker. Shortly after, she received a call from her cardiologist saying the appointments have been rescheduled indefinitely. As she told CNN, “It’s scary, because it makes me realize how reliant I am on a functioning medical system. I took it for granted. I’ve always been around really good care. It’s terrifying to think if anything happened now, it would be completely out of my control.”

The pandemic may lead to feelings of anxiety and helplessness in your patients, especially if they regularly depend on a functioning healthcare system. Reach out to your patients and encourage them to utilize telehealth and other ways of accessing care. Keep them informed during the situation so they have an idea of when they may be able to reschedule non-essential appointments and procedures.