As the coronavirus continues its relentless spread, hospitals are making tough decisions about postponing or canceling elective procedures.

Earlier this week, the Centers for Medicare and Medicaid Services recommended that providers consider a range of factors in determining whether to postpone surgery or other procedures. They include patient risk, urgency of the procedure, bed availability, staffing and the availability of personal protective equipment.

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” CMS Administrator Seema Verma said in a statement Wednesday.

The University of Kansas Health System, which operates the area’s largest hospital, has indefinitely postponed all elective procedures.

“It’s part of our conservation efforts to make sure that we have enough supplies,” said spokeswoman Jill Chadwick. “And it's to help protect patients whose annual check-up, etc., can wait. We know social distancing works and we are assessing everyday how to do our part.”

In a conference call with reporters Friday, Steve Stites, KU’s chief medical officer, said the hospital’s operating rooms were currently operating at about 25% capacity because most elective procedures had been canceled or deferred.

He said KU had prioritized cases into three tiers: ones that can readily be postponed, such as cosmetic surgery; ones with a risk of harm, where the physician and patient need to make an informed decision about what the relative harm and risk may be; and ones that can't be postponed.

“So cases that you have to do are cancer surgery,” Stites said. “You can’t let the tumor grow.”

Stites said the measures were being taken to conserve personal protective equipment in the expectation of an influx of COVID-19 patients in coming weeks.

“We're trying to conserve as much as we can right now for the eventual rapid increase in the number of COVID-19 patients inside the hospital,” Stites said. “And that’s the reason we've been holding back surgery, in order to preserve our personal protective equipment.”

At Saint Luke’s Health System, another large hospital network, elective procedures are being deferred, although what constitutes “elective” in some cases is being left to physicians’ discretion.

“We are deferring all cases that can be safely deferred,” spokeswoman Laurel Gifford said. “Some technically elective procedures are still medically necessary so our physicians and surgeons are reviewing them on a case-by-case basis. But I think it’s safe to say that all cases that are not required at this point and where it’s in the best interests of the patient, are being rescheduled and deferred to a later date.”

HCA Midwest Health, the largest hospital operator in the Kansas City area, said it’s following CMS’ guidelines but also deferring to the clinical judgment of its physicians.

“Our COVID-19 preparedness efforts include reinforcing infection prevention protocols and guidance from the CDC, sourcing necessary supplies and equipment, and emergency planning, so our hospitals are prepared to safely meet the needs of all of our patients and protect the health and well-being of our colleagues,” HCA spokeswoman Christine Hamele said.

Safety-net hospital Truman Medical Centers is postponing “anything that’s true elective surgery,” according to spokeswoman Leslie Carto.

“There are some, like a malignancy that can possibly wait but they have the diagnosis, those are being done. But anything truly elective – those are being canceled,” Carto said.

At least one local healthcare provider, AdventHealth System, which operates AdventHealth Shawnee Mission (formerly known Shawnee Mission Medical Center), has not postponed elective procedures.

“We haven’t told (physicians) that they need to cancel things. I will tell you that’s something that’s being reviewed daily and that position can change,” Adventist spokeswoman Morgan Shandler said.

At the top of its website, AdventHealth posted this notice: “While preventing the spread of COVID-19 and treating COVID-19 patients is of highest priority in our community, we recognize that we have many patients with medical needs unrelated to COVID-19 that still need addressed. At this time, AdventHealth Shawnee Mission has not cancelled or delayed scheduled procedures. However, individual physicians are reviewing their scheduled cases and may opt to postpone elective cases that are not time sensitive. If your case will be postponed, your physician’s office will contact you directly. We will continue to update this policy as the situation with COVID-19 evolves.”

Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.

