Released: 5/10/2020 9:27:46 AM
By Scott Scanlon
Published 5:00 a.m. May 10, 2020
Leaders of three large medical practices expressed gratitude this weekend that state officials will start to allow elective surgeries in some Erie County hospitals.
Thousands of procedures in the county have been postponed by orthopedists, gastrointestinal specialists, neurosurgeons and other physicians since March 16, when Gov. Andrew M. Cuomo ordered a halt to non-emergency surgeries to help slow the spread of the novel coronavirus.
Health care leaders hope free-standing outpatient surgery centers and the two busiest hospitals – which combined handle the bulk of those procedures – will also get the green light soon.
“In the middle of March, we basically told patients, 'You're going to have to wait six to eight weeks while we prepare the hospitals for a potential tsunami of critically ill patients,’ which we're lucky did not appear,” said Dr. Kevin Gibbons, executive director of the UBMD Physicians Group.
“Those six weeks have passed and their surgeries need to be done,” he added. “We've also gotten additional patients on a day-to-day basis.”
Lt. Gov. Kathy Hochul, overseeing the reopening effort in the region, said Friday that Millard Fillmore Suburban and Oishei Children’s hospitals, both part of Kaleida Health, will resume elective procedures in coming days, joining three Catholic Health acute-care facilities: Sisters of Charity, Mercy and Kenmore Mercy.
Erie County Medical Center and Buffalo General Medical Center – which, along with Sisters of Charity, St. Joseph Campus care for the bulk of Covid-19 patients not in nursing homes – continue to await approval.
Those who work in free-standing surgery centers across the county also bide time.
Many surgeons who perform procedures in those outpatient centers also handle the same surgeries on higher-risk patients in hospital operating rooms – including rooms at Buffalo General and ECMC.
Dr. Leslie Bisson, president of UBMD Orthopaedics & Sports Medicine, is among those eager to resume them.
Patients who tore ligaments or await joint replacements did their best to manage pain and struggled with sleep for four or five weeks, he said, but for many of them, it’s now been seven weeks – and counting.
“These are patients who are suffering,” Bisson said.
“I don’t like the term ‘elective surgeries,’ ” he added. “If you dent a car, you can still elect to drive it. If you don’t change your oil or have a flat tire, you can still drive it, too, but for how long?”
Every elective surgery waiver application that has been submitted to the state is being reviewed, including those for ambulatory centers, Hochul said Friday. She acknowledged people have been waiting several weeks.
"We understand that,” she said, “but they also understand that we had to make sure we were prepared for the worst-case scenario.”
The number of patients hospitalized with Covid-19 in Erie County has fallen in recent days, including those who need care in intensive care units.
Meanwhile, more than 1,600 non-emergency surgeries have been canceled or postponed at Buffalo General and Gates Vascular Institute, said Gibbons, also chief of neurosurgery at Kaleida Health.
“Typically in terms of surgery, we do about 1,100 on a month at Buffalo General, and in April we did about 240," he said. “I’m not even talking about cardiac catheterizations and GI procedures, which are huge numbers at Buffalo General and the institute.”
At ECMC on Saturday, 29 of 62 ICU beds – 47% – were empty.
Of the 294 medical-surgical beds, 111 – or 38% – also were available.
Doctors collectively have canceled or postponed 1,300 elective surgeries in recent weeks, including 750 they deemed urgent or priority cases, hospital spokesman Peter Cutler said.
ECMC lost $16.8 million for lack of such surgeries since the pandemic began, accounting for more than half of its $26.5 million in revenue generating losses, Cutler said.
UBMD Orthopaedics has postponed more than 2,000 surgeries, said Bisson, also chair of the Department of Orthopedic Surgery at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
More than 1,200 other procedures also are on hold throughout the UBMD group.
Gibbons said a surgeon typically needs a team of eight others to help with procedures, scheduling, billing and other duties. With less work, UBMD’s 18 group practices have cut physician pay and reduced hours for other workers, he said.
Buffalo Medical Group has done the same, and has also temporarily laid off employees, impacting roughly half of its 850-member workforce, said Dr. Robert Zielinski, associate medical director.
The major practices also have dramatically changed the way they do business. They’ve ramped up telehealth visits, as well as infectious disease control in offices where they still need to see and treat many patients in person.
Providers are concerned that too many patients with chronic conditions are avoiding both those options.
“The focus has been appropriately on inpatient and acute care that the coronavirus has brought on,” Zielinski said. “But I think an underappreciated side effect that can be just as important – and have some long-term implications – is the way regular, everyday health care doesn't just take a holiday. Because of this pandemic, it’s kind of been put aside.
“Limited interruptions with some of these things is not the end of the world,” he said, “but it does create a snowball effect” for patients, medical practices and the health care system.
“Most colon cancers these days are diagnosed on screening colonoscopies,” he said. “If you’re not doing screening colonoscopies, you’re not finding cancers.”
Safely resuming surgeries and other procedures will signal that the health community can address Covid-19 and other concerns, Zielinski said.
UBMD orthopedic surgeons handle roughly half their outpatient procedures at the Millard Fillmore Surgery Center in Amherst and Southtowns Ambulatory Center in Orchard Park, Bisson said.
Very few of their patients, including those who undergo surgery in hospitals, need an ICU stay. If they do, it’s generally for less than a day.
The centers quickly ceased operations in preparation for a feared Covid-19 surge. They can do so again if needed, Bisson said.
“These spaces are also segregated, and have no patients with Covid-19,” he said.
Like hospitals already given waivers to resume elective surgeries, the centers will gradually reschedule patients who are waiting, test them for the new coronavirus three days before surgery, request they quarantine after testing and screen them for flu-like symptoms when they arrive for procedures.
Bisson said the practice has taken a similar tack with patients who need to come into its offices for treatments short of surgery, including casts, joint injections and physical therapy. Patients are screened for illness, discouraged from bringing others with them and required to wear masks.
Staff in both settings also wear personal protective equipment, which has become more available, and focus on disinfecting along with patient care.
“These places,” Bisson said, “are safer than the grocery store.”