The Centers for Medicare & Medicaid Services (CMS) issued guidelines for non-emergent, non-COVID-19-related healthcare as facilities reopen.
In March, CMS recommended that healthcare providers postpone elective procedures until further notice to preserve personal protective equipment. An April 16 White House recommendation gave the green light for elective surgical procedures to resume.
CMS now says, in a notice dated June 8, that facilities should check with state and local authorities to confirm if gating criteria (symptoms, cases and hospitals) have been met in their area. For states with no evidence of meeting gating criteria, CMS recommends optimizing telehealth and continued shelter in place for individuals at higher risk for COVID-19.
For healthcare systems that are opening, CMS said facilities must preserve the capacity to care for potential surges of COVID-19 patients and the fluctuations of COVID-19-related needs.
The CMS guidance says to prioritize at-risk populations who would benefit most from the now available services, such as those with serious underlying health conditions, those at risk for delayed care complications and those without access to telehealth.
Participation in a registry or national data collection system is strongly encouraged to track patient outcomes, facility and system impacts and resource allocation. The data collected could inform the region and state as it considers moving phases in the reopening process.
Other suggestions include viral testing when possible performed 24 hours prior to the procedure or admission for patients. If testing is unavailable, they should self-isolate for 14 days to minimize the risk of virus transmission from an asymptomatic but COVID-19-positive person.
When patients test positive for COVID-19, the clinical team is urged to consider the risks and benefits of proceeding with or postponing the procedure. If the procedure is carried out, the care should be delivered in a COVID-19 care zone with appropriate precautions.
Staffers have been told to wear surgical masks at all times, unless delivering care requiring an N95 respirator, while every effort should be made to preserve personal protective equipment (PPE). Patients and visitors should also wear face coverings that can be brought from home.
CMS mandates that the workforce should be sufficient enough to respond to potential COVID-19 surges as necessary, while staffers should be routinely screened for symptoms. Those who work in non-critical care areas should not rotate into COVID-19 zones unless necessary.