The Centers for Medicare and Medicaid Services (CMS) released on Sunday a set of guidelines on how hospitals are allowed to reopen for non-emergent non-COVID-19 healthcare amidst the COVID-19 pandemic. The guidelines show how hospitals can offer services for patients while at the same time being open to treating patients with COVID-19.
To slowly transition facilities to be fully functioning, hospitals will have to undergo a phased process, much like other businesses and workplaces across the nation who are having state outline phased plans for reopening. The CMS outlines that non-COVID-19 care should be offered to patients as clinically appropriate within a state, locality or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary. The CMS asks healthcare organizations to assess if they have adequate facilities, workforce, testing and supplies, as well as an adequate workforce across different phases of care (i.e. clinicians, nurses, pharmacy, post-acute care, etc.)
In order for healthcare facilities to have the flexibility to re-start clinically necessary care for patients with non-COVID-19 symptoms, the CMS offers these considerations:
• In coordination with State and local public health officials, evaluate the incidence and trends for
COVID-19 in the area where re-starting in-person care is being considered.
• Evaluate the necessity of the care based on clinical needs. Providers should prioritize
surgical/procedural care and high-complexity chronic disease management; however, select
preventive services may also be highly necessary.
• Consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of
COVID-19, including temperature checks. Staff would be routinely screened as would others who will
work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the
• Sufficient resources should be available to the facility across phases of care, including PPE, healthy
workforce, facilities, supplies, testing capacity, and post-acute care, without jeopardizing surge
Personal Protective Equipment
• Consistent with CDC’s recommendations for universal source control, CMS recommends that
healthcare providers and staff wear surgical facemasks at all times. Procedures on the mucous
membranes including the respiratory tract, with a higher risk of aerosol transmission, should be done
with great caution, and staff should utilize appropriate respiratory protection such as N95 masks and
• Patients should wear a cloth face covering that can be bought or made at home if they do not already
possess surgical masks.
• Every effort should be made to conserve personal protective equipment.
• Staff should be routinely screened for symptoms of COVID -19 and if symptomatic, they should be
tested and quarantined. Staff who will be working in these NCC zones should be limited to working in
these areas and not rotate into “COVID-19 Care zones” (e.g., they should not have rounds in the
hospital and then come to an NCC facility).
• Staffing levels in the community must remain adequate to cover a potential surge in COVID-19 cases.
• In a region with a current low incidence rate, when a facility makes the determination to provide inperson, non-emergent care, the facility should create areas of NCC which have in place steps to reduce
risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the
degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and
minimal crossover with COVID-19 areas).
• Within the facility, administrative and engineering controls should be established to facilitate social
distancing, such as minimizing time in waiting areas, spacing chairs at least 6 feet apart, and
maintaining low patient volumes.
• Visitors should be prohibited but if they are necessary for an aspect of patient care, they should be
pre-screened in the same way as patients.
• Ensure that there is an established plan for thorough cleaning and disinfection prior to using spaces or
facilities for patients with non-COVID-19 care needs.
• Ensure that equipment such as anesthesia machines used for COVID-19 (+) patients are thoroughly
decontaminated, following CDC guidelines.
• Adequate supplies of equipment, medication and supplies must be ensured, and not detract for the
community ability to respond to a potential surge.
• All patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility,
and staff must be routinely screened for potential symptoms as noted above.
• When adequate testing capability is established, patients should be screened by laboratory testing
before care, and staff working in these facilities should be regularly screened by laboratory test as
Throughout this pandemic, hospitals have been hit hard financially. The CMS offered support through accelerated payments and by encouraging more telehealth, but some issues cannot always be addressed via telehealth.
Read the original article from Modern Healthcare here.
Read the official guidelines from the CMS here.