Editor’s note: This op-ed was first published by Medpage Today on April 26, 2021.
With each wave of COVID-19 cases, hospitals have scrambled to add more beds while simultaneously cancelling surgeries. The latest example is Michigan, where hospitals postponed procedures because of the crush of COVID-19 patients filling beds and emergency rooms.
Non-COVID-19 patients are at best inconvenienced by the postponements, and at worst imperiled. Hospitals now face a long-term question: How can they increase surge capacity in a crisis without abandoning other patients?
Wider Use of Minimally Invasive Surgeries
Over the past 40 years, scores of operations using arthroscopic, catheterized, or laparoscopic devices have taken the place of more intrusive open surgeries, ranging from lumbar fusions to appendectomies. They typically result in less pain and fewer complications, require fewer hospital resources and shorter hospital stays, and enable faster recuperation. Look no further than Mick Jagger, who in 2019 at 75 years old reportedly had a heart valve replaced via a minimally invasive procedure and was back onstage at full throttle in a little over two months.
But adoption of the required technologies is far from universal. For example, the share of appendectomies performed using minimally invasive technology can be as high as 93% in some hospitals but as low as 41% in others. In Europe and Vietnam, roughly half of all mitral valve surgeries are performed through minimally invasive approaches, but in the U.S., they account for just 23%.
Payment Systems Pose Barriers
Hospitals may like how minimally invasive procedures help patients, but the complex rules governing inpatient reimbursements often favor longer stays that use more labor and other resources. Such models can result in hospitals making smaller profits on minimally invasive procedures – particularly those that involve expensive implantable devices – compared to open surgeries. It should come as no surprise that such reimbursement schedules discourage the adoption of new technologies that could free up hospital capacity and staff for use during pandemic and other surges – after all, healthcare firms reliably respond to financial incentives.
COVID-19 Should Force Another Look
As big savers of bed days, minimally invasive operations can create more healthcare system agility. A study in one Italian hospital found that patients undergoing open surgery for mitral valve repair stayed in the hospital for 11 days on average, compared to an average of five days for patients who had the repair via minimally invasive means. This saved capacity could be used to increase hospital revenues by treating more valve repair patients, but it could also be used as surge capacity for additional patients. Importantly, such a shift increases capacity not just of hospital beds, but also of medical staff.
These procedures can also help prevent the enormous long-term costs associated with delaying regular care. New research suggests that while the direct impact of COVID-19 is large, the impact of regular care foregone or postponed may be much greater. To prevent this as much as possible during COVID-19 and future crises, hospitals need to find ways to keep surgical rooms open.
Fee-for-Service Hurts Progress
Because fee-for-service payment models do not account for low-probability, high-cost events such as hospitals exceeding capacity during emergency surges, hospitals tend to under-invest in technologies that address such events. To address this, Medicare and private health insurers need to embrace a more holistic notion of the value of minimally invasive procedures. Reimbursement schedules should explicitly acknowledge the ability of these techniques to reduce disease transmission by enabling patients to leave hospitals quickly, conserve healthcare resources as a strategic reserve, and keep surgeries moving forward, particularly in the context of a crisis.