Today, the New York State Department of Health issued updated guidance for Resumption of Non-Essential Elective Surgeries and Non-Urgent Procedures in Hospitals, Ambulatory Surgery Centers, Office Based Surgery Practices and Diagnostic and Treatment Centers.
Key updates include:
Hospitals in all counties may resume non-essential elective surgeries and non-urgent procedures in both inpatient and outpatient settings. Waivers are no longer required.
Hospitals should continue to monitor metrics, however, original thresholds of ICU total bed capacity, ICU bed capacity, and COVID hospitalization rate based on the HERDS survey data will no longer be used to qualify hospitals to resume and continue to perform non-essential elective surgeries and non-urgent procedures.
There is no longer a requirement to submit information about the types and numbers of surgeries and procedures to the Department on a monthly basis however, hospitals should have a mechanism to report this information to the Department if requested in the future.
The test period may now be extended from three days to five days prior to the surgery or procedure. Test results should be received and reviewed before conducting the surgery or procedure. The only exception would be a nonscheduled emergent procedure where testing prior to surgery may not be feasible. In this case, a thorough screening and history should be taken as well as appropriate precautions. A test should be performed as soon as possible, and if positive, may result in the need for health care worker exposure protocols to be followed. Providers do not have to perform the test; it is allowable to accept a third-party test provided it is a viral molecular assay as described above and is performed by a laboratory with any required permits and approvals.
The intention was clarified for for ambulatory facilities to maintain ongoing confirmation of local hospital capacity (bed census, ICU census, and ventilator availability). The intention of this guidance is for ASC, OBS, and DTC providers to monitor capacity at the hospitals to which they would normally be transferring to and/or recommend patients visit post procedure, if necessary. Providers should establish their own policies for frequency of monitoring and may monitor local hospital capacity by region at the following link: https://forward.ny.gov/early-warning-monitoring-dashboard.
There has been no change to the requirement for ASCs, OBSs and DTCs to have adequate PPE and medical and surgical supplies appropriate to the number and type of procedures to be performed. Adequate PPE means that an ambulatory provider has at least a seven-day supply of PPE on hand, and the provider’s supply chain can maintain that level to support outpatient surgeries and procedures without resorting to contingency or crisis capacity strategies. To prepare for a potential future surge, providers should be working towards having immediate access to a 90-day supply of PPE.
If a worker reports that they are sick due to a workplace exposure, you must contact your workers’ compensation insurance carrier immediately.
The insurance carrier then has 18 days to act on the claim and must begin paying benefits within this time frame if the claim is accepted.
Effective immediately, the AAOS Registry Program will begin collecting COVID-19 data through the capture of the ICD-10 code for COVID-19 confirmed diagnosis, U07.1. The new code is enabled across each of the AAOS registries, including: the American Joint Replacement Registry, the world’s largest national registry of hip and knee joint replacement data by annual procedural count; the Shoulder & Elbow Registry; the Musculoskeletal Tumor Registry, and the American Spine Registry, a collaborative effort between the American Association of Neurological Surgeons (AANS) and the AAOS.
The AAOS has taken swift action to understand COVID-19’s current and future impact on musculoskeletal care. With more than 1.97 million procedures across four registries, the AAOS Registry Program already collects clinical data to support orthopaedic surgeons, hospitals, health systems, and ambulatory surgery centers (ASCs) in providing the highest quality musculoskeletal care. Now more than ever, it is critical to collect data that will provide additional insights on the quality of care and outcomes of orthopaedic patients in the COVID-19 environment.
WHAT WILL THE DATA REVEAL?
By adding the ICD-10 code to the AAOS Registry Program, sites who contribute the data will have the ability to monitor the impact of COVID-19 on patients undergoing future joint replacement procedures. Tracking COVID-19 data will help analyze the impact of COVID-19 on outcomes, trends of surgery based on the pause in elective surgery, and the trends of patient-reported outcomes (PROMs) due to delayed procedures. It will also track the potential impact on CMS value-based payment models and coverage for patients recovering from COVID-19. On a broader scale, long-term data from the registries may allow for future insights into COVID-19 and its impact on clinical outcomes.
Key learnings from the AAOS Registry Program will be delivered to participants, the orthopaedic community, and the broader public throughout the coming years.
HOW ARE CURRENT AND NEW REGISTRY PARTICIPANTS IMPACTED?
Hospitals, health care systems, practice groups, and ASCs already participating in the registries will not need to join a new registry or engage in a new way to submit their data. Capturing this code will not change the site’s workflow since it was added as an accepted value for existing diagnosis or comorbidity code files. The ICD-10 code can be submitted as a pre-operative comorbidity or prior diagnosis present on admission and as a reason for readmission.
Participants who have questions about submitting the new code can reach out to AAOS Registry Support at RegistrySupport@aaos.org for assistance. To enroll in a Registry, contact an AAOS Registry Engagement Associate via email RegistryEngagement@aaos.org or phone 847-292-0530.
Our patients are finally getting the high-quality care they deserve as state and local governments continue to relax restrictions on surgical practices. Most importantly, this care is being provided in an environment that is safe for patients, staff, and society. All those involved in patient care—including the patients themselves—understand that certain aspects of our practices have changed. The need for social distancing requires that we see fewer patients and utilize telemedicine whenever possible. We are becoming accustomed to wearing masks during office hours and our patients welcome symptom screening before being seen. COVID-19 antigen testing is being required by many institutions prior to surgery and this has been well received by patients. Despite the inconvenience, they understand and appreciate the steps we are taking to protect them. In short, we are all getting used to the “new normal.”
> Read more
Under the Paycheck Protection Program (PPP) created by the CARES Act, loans may be forgiven if borrowers use the proceeds to maintain their payrolls and pay other specified expenses.
The Treasury Department and Small Business Administration recently released the application form and instructions for loan forgiveness. The forgiveness forms, instructions, and worksheets can be downloaded here.
PPP borrowers must apply for loan forgiveness with the lender that processed the loan.
This Guidance is directed at Ambulatory Surgery Centers (ASC) Office Based Surgery practices (OBS), and Diagnostic and Treatment Centers (DTC) that are located in counties without a significant risk of COVID-19 surge and are deemed eligible to perform Deferred Procedures, (i.e., elective surgeries and non-urgent procedures).
These centers and practices are required to meet the same provisions required of hospitals in these eligible counties that are also resuming deferred procedures.
Any ASC, OBS, or DTC that fails to comply with this Guidance may be subject to civil penalties.
The House of Representatives passed the Health and Economic Recovery Omnibus Emergency Solutions Act (H.R. 6800), which includes over $3 trillion in funding for state and local governments, hospitals and physicians, payments to individuals, and other assistance.
> Access the AAOS Summary
In this pre-recorded webinar, the Joint Commission provides an overview of COVID-19 routes of transmission and focuses on prevention strategies for freestanding surgical centers to consider prior to resuming elective procedures: Preventing Coronavirus Transmission in Ambulatory Surgery Centers
As the world’s largest medical association of musculoskeletal specialists, AAOS announced in November 2019 a strategic investment in the field of biologics and future disruptive technologies. Over the next five years, AAOS will prioritize research and development for a biologics-focused competency addressing issues of unreliable information and patient receipt of substandard care from nonorthopaedists, as well as continuing to be the trustworthy source of information for patients, members, and external providers and payers. This reprioritization is an expansion of previous work of many members on previous committees who also worked in this space.
The Centers for Medicare & Medicaid Services (CMS) issued another round of regulatory waivers and rule changes with the goal of increasing diagnostic testing and access to medical care during the COVID-19 pandemic.
The AAOS Office of Government Relations has developed an overview for members with high-level key points
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
Address: PO Box 38004, Albany, NY 12203