Don’t expect a quick return to elective surgeries delayed by the virus

The coronavirus pandemic has created unprecedented responses from governmental agencies across the globe. In the United States, one such measure was reducing allowed surgeries to include only those necessary to treat emergent or time-sensitive problems. The intention of these restrictions was to prevent utilization of health care resources that might be required during the peak of the pandemic’s effects in the United States. As the prospective peak time of COVID-19 cases draws closer, governmental agencies have been provided a clearer picture of necessary resources that allows for a gradual relaxation of restrictions imposed in preparation for worst-case scenarios.  

President Trump has outlined his plans for economic recovery to the general public and in private meetings with governors from across the country. Three governors — Kevin Stitt of Oklahoma, Greg Abbott in Texas and Alaska’s Mike Dunleavy — in consultation with their advisory groups subsequently have reduced their states’ restrictions on elective surgeries. These moves are critical to economic recovery, given that most hospitals significantly depend on elective surgery revenue for profit margins, especially critical access hospitals in rural areas. 

In addition, health care represents approximately 18 percent of the GDP, so any financial improvements in the health sector can quickly help to stabilize state and national economies.  While many elected officials were able to efficiently switch off elective surgery, it cannot simply be switched back on.  

The first major barrier to performing elective surgeries is the financial ability of patients to afford the procedure. A significant percentage of the working population has been furloughed or become unemployed. This has led to financial uncertainty for many patients. In addition, most health insurance companies and employers have focused on increasing patient responsibility through deductibles and copays. The goal of these cost-sharing initiatives is to discourage over-utilization of procedures and reduce health care spending. Unfortunately, in times like these, the goal should be not to reduce utilization, but instead to encourage patients to pursue surgeries necessary to ensure that they remain productive in the workplace.

Another significant barrier is whether or not employers will allow for paid time off. Many employers do not provide paid time off upon hiring, and many employees have expended their paid time off during this pandemic. As businesses attempt to return to normal in given sectors, employers will be hesitant to allow employees to take time away from work so soon after reopening.

The final barrier is the ability of employees to have insurance to help pay for the procedure. The American health care system has been dependent on employers to provide insurance since the early 1940s in the post-war era. Today, nearly 50 percent of Americans receive their insurance coverage from their employers. Those who have become unemployed or had their employment reduced may lack access to appropriate benefits or be unable to afford premiums and the previously mentioned patient responsibility components. Making matters worse, even if someone is rehired during the economic recovery, they still may be ineligible for health insurance benefits through their employer for several months.

Congress has acted swiftly and aggressively in attempting to protect American citizens from the economic impact of the pandemic through legislative and regulatory actions such as the CARES Act. Future legislation will need to address the above barriers to ensure that patients can obtain the care they intended to pursue before the pandemic. This will need to come in the form of expanding COBRA benefits to allow for those who are unemployed to maintain coverage.  

In addition, employers and employees will need further economic relief to cover the cost of paying premiums and deductibles to insurance companies. Tax deductions or credits can be introduced to offset premiums, copays, coinsurance and deductible payments made by the employer or employee for costs incurred during 2020. Similar deductions or tax credits could be considered for the employer to account for paying time off to employees who pursue surgical treatments.  

Legislative and regulatory actions implemented today can help patients pursue necessary treatments, return to meaningful employment, and stabilize the economy. While long-term issues need to be addressed in our health care system, we must act now to reduce economic barriers and ensure that our workforce is healthy and able to participate in the long-term economic recovery.

Dr. Adam Bruggeman is a spine surgeon in Texas, board certified in both orthopaedic surgery and addiction medicine. He is a member of the board of councilors for the American Academy of Orthopaedic Surgeons and the recent past president of the Texas Orthopaedic Association. Follow him on Twitter @DrBruggeman.