This is a big ouch for the medical device industry.
As coronavirus spreads across the U.S., many hospitals and health systems are canceling elective surgeries to dedicate resources to its coronavirus response. The question is, for how long? We are tracking this and will provide more information as we get it.
These are notable healthcare organization and we provide a list of the first 36 to announce they will defer appropriate elective and non-urgent care[i], some on an indefinite basis.
Even more important; are the CMS guidelines listing the elective surgeries they recommend for deferment. We list those also.
“The immediate impact on cash flow will hurt many industries;” says Kristine Kopsiaftis Lampert, Managing Director at Fulcrum Partners, experts in executive compensation and benefits consulting[ii]. “Many companies are working hard to balance conserving cash flow and managing supply chain disruptions. We are recommending that our clients review their executive benefit financing strategies for opportunities to conserve cash flow.”
It is no surprise that many of these hospital systems are in areas already hard hit by COVID-19, like NY, NJ, MI or WA. They are:
1.Brigham and Women's Hospital: Boston, MA
2. New York-Presbyterian; New York City; NY
3. Northwell Health; New Hyde Park, NY.
4. Hackensack Meridian Health, Edison, N.J.,
5. Beaumont Health, Troy, MI
6. Hospital for Special Surgery; New York City, NY
7. Tufts Medical Center; Boston, MA
8. Greater Baltimore Medical Center, Baltimore, MD
9. Ascension St. Vincent Hospital; Indianapolis, IN
10. Michigan Medicine; Ann Arbor, MI
11. UW Health; Madison, WI,
12. Swedish Medical Center; Seattle, WA
13. Massachusetts General Hospital; Boston MA
14. Baystate Health; Springfield, MA
15. Mount Sinai Health System; New York City., NY
16. St. Charles Health Care System; Bend, OR
17. University of Utah Medical System; Salt Lake City, UT
18. Intermountain Healthcare; Salt Lake City, UT
19. Memorial Health System; Springfield, IL
20. Catholic Medical Center; Manchester, NH
21. Hartford (Conn.) Healthcare; Hartford, CT
22. Fayette County Memorial Hospital; Washington Court House, OH
23. Mayo Clinic; Rochester, MN
24. Butler (PA.) Health System; Butler, PA
25. Augusta (GA) University Health: Augusta, GA
26. Beaumont Health: Royal Oak, MI
27. Baptist Health: Richmond, KY
28. Geisinger; Danville, PA
29. HealthPartners; Bloomington, MN
30. NCH Healthcare System; Naples, FL
31. Northwestern Medicine: Chicago, IL
32. Penn State Health; Hershey, PA
33. St. Luke’s; Duluth, MN
34. UNC Health Care: Charlotte, NC
35. Duke Health: Durham, NC
36. WakeMed; Wake Forest, NC
All elective surgeries recommended by CMS and other organizations[iii] to be postponed stipulate that they based on the judgement of the physician. Many are listed ‘Postpone if Possible’:
Breast Surgery
· Excision of benign lesions-fibroadenomas, nodules, etc…
· Duct excisions
· Discordant biopsies likely to be benign
· Breast High risk lesions-atypia, papillomas, etc…
· Prophylactic surgery for cancer and noncancer cases
· Delayed SNB for cancer identified on excisional biopsy
· cTisN0 lesions-ER positive and negative
· Re-excision surgery
· Tumors responding to neoadjuvant hormonal treatment
· Clinical Stage T1N0 estrogen receptor positive/progesterone receptor positive/Her2 negative tumors*
· Inflammatory and locally advanced breast cancers†
*These patients can receive hormonal therapy.
†These patients should receive neoadjuvant therapy.
Bariatric Surgery
· Bariatric: primary gastric bypass, sleeve, duodenal switch, gastric band
· Revisions for weight gain
GI & GI Surgery
· Upper and lower GI procedures
· All endoscopies
· Malignant polyps, either with or without prior endoscopic resection
· Prophylactic indications for hereditary conditions
· Large, benign appearing asymptomatic polyps
· Small, asymptomatic colon carcinoids
· Small, asymptomatic rectal carcinoids
· Acute Hemorrhoidal Thrombosis/Necrosis
· Perianal or Perirectal Abscess
· Soft Tissue Infections
· Acute Pancreatitis with Necrosis
· Appendicitis, Uncomplicated
· Symptomatic Cholelithiasis
· Choledocholithiasis
· Cholangitis
· Uncomplicated Diverticulitis
Orthopedic
· Non-urgent spine
· Hip, knee and elective spine surgery
· Stable ureteral colic
· Elective angioplasty
Women’s Health
· Treatment for abnormal uterine bleeding
· Surgery for fibroids (sarcoma is not suspected)
· Myomectomy
· Hysterectomy
· Surgery for endometriosis, pelvic pain
· Surgery for adnexal masses that are most likely benign (e.g., dermoid cyst)
· Surgery for pelvic floor prolapse
· Surgery for urinary and/or fecal incontinence
· Cervical conization or Loop Electro-Excision Procedure for high grade squamous intraepithelial lesions
· Infertility procedures (e.g., hysterosalpingograms, most elective embryo transfers)
· Excision of condyloma acuminata (if cancer is not suspected)
Vascular Surgery
· Bypass graft complications
· AAA < 6.5 cm
· Peripheral Angiograms and endovascular therapy for Claudication
· Surgical Procedures for Claudication
· Lysis, Arterial and venous
· Thoracic Outlet Syndrome, Arterial with thrombosis
· Symptomatic venous TOS with acute occlusion and marked swelling
· IVC filter placement
· Massive symptomatic iliofemoral DVT in low risk patient
· Procedures for Ulcerations secondary to venous disease
· Asymptomatic May Thurner syndrome
· IVC filter removal
· Varicose veins, GSV ablations
[i] https://www.beckershospitalreview.com/patient-flow/12-health-systems-canceling-postponing-surgeries-due-to-the-coronavirus-outbreak.html
[ii] www.fulcrumpartnersllc.com
[iii] https://www.facs.org/covid-19/clinical-guidance/elective-case
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