fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

Coronavirus FAQs: What are elective surgeries, who receives the Provider Relief Fund and more!

May 22, 2020 | FAH Policy Blog Team

Category: General, Health Care Delivery

With countless new guidelines from Congress and the Trump administration in response to the novel coronavirus (COVID-19) pandemic, it can be challenging to cipher through the meaning of complicated legislation and regulations.

But words matter.

Whether in the news media or in policy conversations, there is confusion around a handful of items related to FAH member hospitals and the patients we serve. Those items are explored below:

What are elective surgeries or procedures and why are they important?

Those not involved in patient care tend to view elective procedures as something optional, like cosmetic surgery or routine wellness checks. But the word “elective” can be misleading in that it isn’t referring to the usefulness or medical necessity of the service, but rather to the urgency of the service. “Elective” procedures are often lifesaving and/or preventive but are non-emergency, meaning they can be scheduled in advanced without negatively impacting the patient’s outcome and overall health. The term “elective” includes a wide range of procedures - everything from cancer treatment and essential diagnostic testing to the placement of cardiac stents to joint replacement surgeries. Thus, it is more accurate to refer to these services as non-emergent or scheduled procedures.

In response to local, state, and federal guidance, hospitals across the country stopped these non-emergent procedures in order to allocate more resources and personnel to COVID-19 response. But these decisions by government leaders, which were appropriate at the start of this pandemic, have had negative consequences on patients and the hospitals that serve them. Patients needing care have delayed medically necessary services, which can result in serious complications and poor health outcomes.

In addition, hospitals rely on revenue from these procedures and without them many are struggling to keep their doors open. The American Hospital Association released a study finding hospitals will lose $202.6 billion in expenses and lost revenue from March 1, 2020 to June 30, 2020 – an average of $50 billion per month. A recent FAIR Health study found a national 16% decrease in revenue for large hospitals. Not surprisingly, volume has also been greatly impacted by coronavirus – hospitals and health systems have experienced an average decline in patient volume of 56% over a six-week period in March and April.

Hospitals in hot spots are filled with COVID patients, but in the majority of the country the elimination of non-emergent procedures, combined with the trepidation of patients to seek care during the pandemic, has left facilities empty. Regardless of its prevalence in a community, coronavirus has resulted in devastating impacts across all parts of the health care industry.

What COVID-related services are covered for the uninsured?

Hospitals are there to serve their communities and will treat COVID-19 patients regardless of whether those individuals are insured or uninsured. For insured individuals, some insurance companies have agreed to waive cost-sharing for COVID-19 treatment while others have not waived cost-sharing or have limitations on what services are eligible for those waivers.

For uninsured individuals, Congress passed legislation providing coverage for COVID-19 testing and testing-related services. And the Trump administration set aside funding from Congress to cover COVID-19 treatment for uninsured patients. Unfortunately, that treatment coverage does not extend to all uninsured COVID-19 patients, creating confusion for health care providers and patients and leaving many uninsured individuals responsible for the cost of COVID-19 treatment they thought would be covered by the government.

The administration’s program reimburses health care providers for treatment services when COVID-19 is the primary medical diagnosis. However, many patients have a secondary diagnosis of COVID-19 – in accordance with international medical coding guidelines – with the primary diagnosis representing the serious effects of the virus, such as pneumonia or sepsis. Patients with a primary diagnosis of COVID-19 will have their services covered by the government; in contrast, patients who are seriously ill with pneumonia who have a secondary diagnosis of COVID-19 will not have their services covered by the government.

Are the billions of dollars in the Provider Relief Fund designated for hospitals only?

Press coverage and reporting of recently passed legislation like the Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748, Public Law 116-136) and the Paycheck Protection Program and Health Care Enhancement Act (H.R. 266, Public Law 116-139) often incorrectly infers that all of the funding in the Provider Relief Fund is going to hospitals. In reality, a wide variety of health care providers are eligible for these funds, including physicians, physician practices, ambulatory surgical centers, post-acute care facilities, behavioral health providers, and more.