New ban on elective surgeries carries some big risks
The tragic rise in COVID-19 cases in Arizona in recent weeks makes it clear that the pandemic will be a factor in our lives beyond this summer. As we shift our focus from a crisis mindset to longer-term health care strategies, it is critical that we consider the downstream effects of our public health decisions in the context of this new normal.
One critical area is ensuring that we do no harm when it comes to policies regarding medically necessary surgical procedures, both in terms of municipalities restricting access and proposed federal policies determining reimbursement.
When COVID-19 first emerged this year, state and local governments paused nonemergency procedures, forcing us to postpone many patients needing procedures such as hip replacements, cancer biopsies and heart stents. We did this to ensure that we could be sure that our patients were not being brought into an unsafe environment and so that we could focus medical resources and PPE on COVID-19 patients.
Organizations such as the American College of Surgeons advocated for and supported this pause. In turn, many of my fellow surgeons diverted their attention to caring for those sick with the virus, both in Arizona and in early hotspots elsewhere.
Although the initial ban on elective surgeries was lifted in Arizona on May 1, the renewed surge in cases is driving some states such as Texas and Mississippi to reimpose those bans. As we in Arizona consider similar measures, it’s important to recognize that the deferral of these procedure is brought with it a rising wave of worsening patient outcomes and a significant treatment backlog.
Small independent surgical practices were devastated by the closure, and closing their doors would limit access to surgical care for millions of Americans. Finally, the revenue lost by health systems creates a financial deficit that is jeopardizing the ability to fund other vital health care deliverables, including COVID-19 care.
Nonemergency procedures, such as hernia repairs, are the economic powerhouse of a hospital system because their higher margins support other types of care with lesser reimbursement. By pausing the economic engine of surgery, we are not just risking the health of those waiting for procedures as their conditions worsen.
We also jeopardize patients whose access to health care depends on financially stable institutions. Similarly, prolonged shutdowns are leading many private practice surgeons to consider retiring or closing their doors, further reducing access to these critical procedures for Arizonans.
I fully support temporary bans on nonemergency surgeries when it is necessary to keep patients safe and provide care for COVID-19 patients. But we must recognize and plan for the negative consequences that it causes for patients, surgeons and health care systems.
Unfortunately, there are
also planned, federal policy decisions that are set to compound the impact of the shock caused by COVID-19 on struggling hospitals and surgery practices.
In January 2021, a new rule set by the Centers for Medicare and Medicaid Services will reduce the amount that surgeons are reimbursed for certain procedures. This rule was planned before the pandemic – it wasn’t fair then and it certainly is not now that we see how fragile our system is.
Congress has the ability to protect us from these cuts. Simply put, the middle of a pandemic is not the time to make cuts that will reduce patient access to quality care.
As surgeons, we are struggling like the rest of America as we deal with risks to our patients, ourselves and our futures. We will continue to rise to the challenge of this unprecedented moment, and we will fulfill our oath and our obligation to heal. In turn, we need Congress to protect us.