In another step on the slow march to normalcy, Colorado hospitals, dental offices, optometrists and other health care providers can start seeing patients for elective procedures again this week.
That means many Coloradans no longer need to hold off on non-emergency appointments, a broad umbrella that covers everything from getting your eyes checked or cavities filled to getting spinal surgery or a hip replacement.
Depending on how urgent your need is, though, you may have to wait a few weeks or longer to get on the books. Providers are working to reschedule hundreds or even thousands of patients, and state-mandated health and safety protocols may lengthen the windows between appointments and cap the number of people in offices at a given time. Both UCHealth and Banner Health are resuming only medically necessary elective surgeries — contenders could include some cancer-related, spine, cardiac or gallbladder surgeries, for example. The state is instructing dental offices to hold off on many preventative procedures such as routine cleanings.
Providers also need to get a handle on a bevy of regulatory requirements and recommendations, many of which are only now coming into focus.
“It’s not really a unified message,” said Dr. Adam Timock, a Fort Collins and Windsor orthodontist, during a phone call Monday afternoon. “We’re just kind of scrambling to get the word from everyone.”
Colorado Gov. Jared Polis paused elective surgeries and procedures on March 23, a few days before the statewide stay-at-home order went into effect. The change freed up personal protective equipment and hospital beds as Colorado responded to a rapid uptick in coronavirus infections, but it also resulted in loss of hours for thousands of employees of dental offices, surgical facilities, hospitals and other providers throughout Colorado.
Polis issued a new order allowing elective procedures to continue starting Monday, but the Colorado Department of Public Health and Environment didn’t release detailed requirements for providers until Monday afternoon. Larimer County’s health department initially said it wouldn’t allow elective procedures to resume until May 1 but later changed that date to match the state order, which stays in effect until May 27.
Offices are also responding to requirements and guidelines from other regulatory agencies and professional associations, including the Colorado Dental Association, Colorado Optometric Association and the Occupational Safety and Health Administration, among others.
The confusion means that some offices aren’t yet open for regular business, especially if they were waiting for more specific state guidance or need more time to order protective equipment or other necessities. People looking to book elective procedures and surgeries should contact their provider’s office to see when they’re planning to resume elective appointments.
State guidelines during the safer-at-home order differ based on the type of provider. Some of the universal mandates include enhanced cleaning, requiring staff and patients to wear masks and maintaining 6 feet of separation between people whenever possible.
“Limited health care settings,” including optometry and physical therapy offices, have to cap the number of employees and customers in a location at 10 people or 50% occupancy, whichever is less.
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Hospitals face some of the most stringent requirements for resuming elective procedures.
Large hospitals are required to limit the volume of elective surgeries and procedures to no more than 50% of the annual daily average volume for large health systems. That requirement lasts for the first 10 days of the public health order. Smaller hospitals and outpatient facilities have a cap of 80% of the average daily hospital volume. Procedures should be “limited to those that are time sensitive, diagnostically important and conditions for which further delay would be detrimental to health.”
Hospitals are also expected to keep at least 30% of hospital beds open and maintain adequate staffing so the site is prepared for the possibility of a coronavirus surge.
The state order also instructs hospital leaders to “strongly consider the balance of risks and benefits for patients who are vulnerable individuals,” including the immunocompromised and people over 65.
Banner Health, which operates Banner Fort Collins Medical Center, McKee Medical Center in Loveland and North Colorado Medical Center in Greeley, resumed medically necessary surgeries Monday, spokesperson Sara Quale said.
She said Banner did so only after improving protective equipment supplies, creating additional safety measures and increasing its coronavirus testing capacity. The hospitals will test all scheduled surgery patients for coronavirus and reschedule the procedure if they test positive, Quale said. Staff will also monitor patients’ temperatures regularly.
“We made this decision to fulfill our mission of making life better for our patients,” Quale said in an email. “Patients whose surgeries were delayed more than a month ago now have more urgent needs. We want to do our best to deliver the care they need in a safe and timely manner.”
UCHealth, which operates Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland, also resumed medically necessary surgeries on Monday and will be testing patients for coronavirus before procedures can take place.
Patients coming in for a surgery, procedures or clinic visit will be allowed to have one support person if needed, but no visitors with cold or respiratory symptoms will be allowed, UCHealth spokesperson Kelly Tracer said. UCHealth is also encouraging physical distancing by reducing the amount of furniture in facilities.
Dental offices will also need to change their protocol to resume elective procedures. Dental offices need two weeks’ worth of protective equipment on hand, and many staff will be wearing additional gear such as N95 respirators, face shields, isolation gowns and booties.
They need to space appointments out so there’s time to clean and disinfect the office and equipment and allow aerosolized particles to settle between patients. They’re expected to maintain 6 feet of separation between patients and allow patients to wait outside the office or check in through a virtual waiting room.
Timock plans to resume some appointments as soon as Friday as long as he can make sure his office is meeting all regulatory requirements. The office has been closed for five weeks and has about 1,000 patients waiting to resume in-person appointments.
It’ll take weeks or even months for dental and orthodontics practices like his to catch up on the backlog, Timock said.
“Halting routine patient care for a month will create a huge bottleneck effect,” Timock said. “But on the bright side, most of our patients and families have been super understanding about the situation. Everyone’s going through the same crisis with COVID-19. I think everyone appreciates that the bottom line is, yes, we want to provide the best dental care, but we have to do it when it’s safe.”
Jacy Marmaduke covers government accountability for the Coloradoan. Follow her on Twitter @jacymarmaduke. Support stories like this one by purchasing a digital subscription to the Coloradoan.
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