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Dr. John Wilson: Cutting health care during a pandemic

Dr. John Wilson: Cutting health care during a pandemic

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As a neurosurgeon, one of the most concerning side-effects of this pandemic is the number of people who have delayed seeking care for serious problems. Patients continue to suffer herniated discs and other painful spinal conditions and are forced to delay care. The number of stroke patients coming through our doors has dropped off significantly, yet I know COVID-19 hasn’t impacted the number of strokes that happen. They will end up in our emergency rooms sooner or later, with a more serious condition. And unfortunately, the federal government is getting ready to make this situation even worse by degrading the ability of hospitals and private practice surgeons in North Carolina to deliver quality care.

The Centers for Medicare & Medicaid Services (CMS) announced on Aug. 4 that it would be cutting Medicare payments for surgical practices by as much as 9%. A cut of this magnitude in normal times would be a shock to our health care system. But to make these cuts in the middle of this pandemic is devastating and represents public health malpractice.

These cuts couldn’t come at a worse time for our nation’s surgeons. Surgical practices and hospitals are experiencing the lowest patient volumes in history: a survey in April found that only 8% of hospitals nationwide were still performing outpatient elective or semi-elective surgeries. This drop off created a compounding problem -- both a backlog of progressively more dangerous health issues and a shocking drop in hospital revenues that keep our health care systems financially viable.

Loss of access to care has dramatic consequences. I recently operated on one patient with symptomatic carotid disease on the left side of their neck. We knew he had a severe blockage in an artery on the other side that was asymptomatic and planned to operate on that side after they recovered from the first surgery. However, because of COVID concerns and lockdown measures, the procedure was delayed by more than three months. By the time he was able to come back, the blocked artery had completely shut down, and we could not reopen it at all. It’s fortunate he didn’t have a stroke, but the long-term consequences remain an open question.

If we’d been able to take care of this earlier, we might have kept that blood vessel open through a straightforward surgical procedure and prevented potential future complications. The pause on “elective” surgeries was and is medically necessary to deal with the current COVID crisis – but Medicare cuts will result in more patients dealing with similar delays from an entirely avoidable crisis.

These cuts will hit private practices and hospital systems already in a precarious financial position. Non-emergent surgeries are the economic powerhouse of a hospital system, and the revenues from those procedures make possible all the other care provided to patients. Entire floors of our hospitals sat empty for over a month this spring after we halted all non-time-sensitive procedures when we were asked to do so by the government and public health experts. We lost millions of dollars of revenue that we otherwise could be using now to fund purchase of PPE, critical care equipment and supplies to fight COVID and improve care for all our patients.

Today, our hospitals are back running at or above normal capacity. We are caring for the backlog of patients while continuing to care for patients with urgent medical conditions and providing needed care to the surge of COVID patients we are currently seeing. In order to continue providing the excellent care that all our patients deserve, we are carefully managing resources, including critical care services, surgical services, and PPE. Because of resource restraints and patient concerns related to the ongoing coronavirus pandemic, we are limited in our ability to clear the treatment backlog and help new patients. The difference between this spring and now is that physicians are in an even weaker position financially, and one that is about to get worse.

The fact that CMS is prepared to go ahead with their cuts under these circumstances causes me grave concerns. That is why I urge our representatives in Congress to waive budget neutrality and stop payment cuts to Medicare. We are in the middle of the crisis, and we can’t protect North Carolinians if Washington decides to cut health care funding at one of the most critical moments in our nation’s history.

Dr. John A Wilson is vice-chair of Neurosurgery at Wake Forest Baptist Health and the president of the American Association of Neurological Surgeons. The views expressed in this column are his alone and do not reflect those of Wake Forest Baptist Health.

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