MMA, Specialty Societies and Medical Groups Provide Health Department with Recommendations on Resuming Elective Surgeries and Procedures

May 4, 2020

On May 1, the MMA and 23 Minnesota medical specialty societies and medical groups presented the Minnesota Department of Health (MDH) with recommendations intended to inform changes to Executive Order 20-09 in order to allow Minnesota health care providers to resume the delivery of medically necessary care in a safe, controlled and planful way. 
  
“The medical community supported the March 19 implementation of Executive Order 20-09 to support its goals to preserve and focus attention on the supply of personal protection equipment needed for COVID-19 care; to reduce utilization of hospital bed capacity that may be needed for COVID-19 care and projected surge; and, to focus hospital personnel and resources on pandemic preparation and planning,” wrote MMA President Keith Stelter, MD, to MDH Commissioner Jan Malcolm. 
  
Real progress has been made toward those important goals. The order has also resulted in delays in care that are of increasing concern to physicians due to variable interpretations of the order by medical groups (e.g., assumptions that the “examples of criteria to consider" were exclusive criteria) and fear of violating the order given the potential for criminal prosecution. 
  
“Our recommendations acknowledge the reality of COVID-19 for the foreseeable future and the need to ensure new standards for patient and staff safety, while also recognizing that there are important health care services Minnesotans need that physicians are in the best position to help assess,” said Stelter. 
  
The principles that guided the group’s recommendations were as follows: 

• Responsibly expand the delivery of medically necessary health care services with the best interests of the patient at the center of all decisions. 
• Ensure the health and safety of patients and health care staff. 
• Recognize the dynamic situation associated with the COVID-19 pandemic and be prepared to monitor and adjust, as needed, to changes in local conditions, hospital and ICU capacity, PPE availability, and health care personnel supply that may be needed to meet the critical care needs of COVID-19 patients. 
• Access to sustainable PPE levels is critical to easing restrictions on care delivery, recognizing that supplies need to be well managed in the event of disease resurgence once general societal restrictions are eased. 
• Physician practices are prepared to work collaboratively and transparently with colleagues, facilities, and regulatory agencies to ensure adequate health system capacity for COVID-19 patient care. 
• There are harms associated with COVID-19 morbidity and mortality as well as morbidity and mortality from delayed care and deferred access to needed services in non-COVID-19 patients. 
• Patients should be encouraged to seek medical care if they have concerns, be advised not to delay seeking care, and be confident that seeking care is safe. 
• Easing of restrictions on elective patient care and surgery may be safely undertaken in advance of easing of society-at-large restrictions as medical care facilities and personnel are well trained and able to control the safety and infection transmission risks in those environments. 

Signatories, along with the MMA, included: 

• Center for Diagnostic Imaging 
• Dermatology Consultants 
• Minnesota Academy of Family Physicians 
• Minnesota Academy of Ophthalmology 
• Minnesota Academy of Otolaryngology 
• Minnesota Chapter, American College of Emergency Physicians 
• Minnesota Chapter, American Academy of Pediatrics 
• Minnesota Chapter, American College of Cardiology 
• Minnesota Chapter, American College of Physicians 
• Minnesota Dermatological Society 
• Minnesota Orthopaedic Society 
• Minnesota Radiological Society 
• Minnesota Section, American College of Obstetricians and Gynecologists 
• Minnesota Society of Anesthesiologists 
• Minnesota Society of Interventional Pain Physicians 
• Minnesota Society of Pathologists 
• Minnesota Urological Society 
• Minnesota Urology 
• MNGI Digestive Health 
• Specialists in General Surgery 
• St. Paul Infectious Disease Associates 
• The Orthopaedic & Fracture Clinic
• Twin Cities Orthopedics