- CMS on Wednesday night issued new recommendations urging hospitals to delay non-essential elective surgeries to be more prepared for COVID-19 patients. The guidance gives providers the final decision on what procedures to put off, taking into consideration urgency and available staff, personal protective equipment, ventilators and beds.
- The guidelines break elective procedures down into three tiers. CMS recommends low-acuity services like a colonoscopy in an outpatient setting be postponed, but not transplants, neurosurgery or limb-threatening vascular surgery performed in a hospital. Procedures like hip and knee replacements fall into the "consider postponing" category.
- Also Wednesday, the Senate passed and President Donald Trump signed a coronavirus relief package that among other measures requires public and private health plans to cover the costs of testing at no patient cost and with no prior authorization.
Before the guidance from CMS, several major health systems had already moved to defer elective surgeries as they brace for an influx of coronavirus patients. On Sunday, U.S. Surgeon General Jerome Adams pushed for such measures, saying hospitals should preserve PPE, avoid exposing other patients and keep staff focused on outbreak response.
Hospitals pushed back on the idea of blanket mandates, but the CMS recommendation provided nuance based on the type of procedure, where it is performed and the health of the patient.
Elective procedures tend to be lucrative for medtech companies. Moody's earlier this week downgraded the sector, predicting hospitals would shift capacity to treating infected patients and postpone elective procedures such as hip and knee replacements.
The rating's agency looked to the recession of 2008-2009 to game out what a medtech slowdown could look like. Sales of critical products such as cardiology devices were less affected during that period, while orthopaedic procedure volumes were flat in 2009 before rebounding to a 3% to 4% growth rate soon after, Moody's said.
A survey of more than 60 orthopaedic surgeons, interventional cardiologists and anesthesiologists published last week by investment firm Jefferies suggested U.S. cancellations and delays were already on the rise. That came before the World Health Organization declared the outbreak a pandemic.
The Jefferies survey found 23% had already noticed an increase in deferrals and cancellations, with more than half of respondents expecting the trend to continue. Cardiologists saw the highest impact at 29%, followed by orthopaedic surgeons at 23% and anesthesiologists at 13%.
According to last week's estimate, the U.S. could see 3% to 4% of procedures impacted across orthopaedics and interventional cardiology.