Hospitals throughout much of Western New York soon can resume elective surgeries, but a ban on those procedures remains in place in Erie County.
Medical centers outside the region's most populated county that demonstrate they have the capacity to handle a potential future surge in Covid-19 patients can schedule elective surgeries starting April 28.
So colonoscopies, rotator-cuff surgeries and similar procedures on hold since March 25 tentatively can begin again in Niagara and Genesee counties and other outlying counties.
Health care leaders – even those in Erie County – welcomed the news but said they will wait for more guidance from the state.
"I think we're going to ramp up slowly and cautiously," said Joseph A. Ruffolo, president and CEO of Niagara Falls Memorial Medical Center.
The state halted elective surgeries last month in an effort to stem the spread of Covid-19 and to ensure hospitals had enough protective equipment and available beds to safely care for patients with the virus.
But the ban dealt a significant financial blow to hospitals and physician practices as they lost revenue from the procedures. Many medical centers didn't see a surge in coronavirus patients.
That's why Gov. Andrew M. Cuomo on Tuesday said he was ready to let many – but not all – hospitals restart these procedures as long as they can demonstrate Covid-19 isn't a problem for them.
"It won’t include Erie County or Albany County or Dutchess and several other counties where we still need to protect those hospital beds in case we need them for Covid," Cuomo said during a news briefing at Roswell Park Comprehensive Cancer Center in Buffalo.
The ban on elective procedures went into effect when the coronavirus was beginning to spread rapidly, particularly downstate.
Officials feared hospitals would run out of beds, masks, gowns and other equipment needed to care for patients with the virus.
While the coronavirus has touched every part of the state, there are large swaths where hospitals haven't been overwhelmed by Covid-19 cases.
With elective procedures banned and emergency room visits and other patient counts dropping sharply, a number of hospitals have turned to furloughs and pay cuts to make up for the lost revenue.
"In those parts of the state and in those hospitals where the hospitals are laying off people because they are so quiet, and they have the capacity and capacity for the virus is not an issue, we’re going to allow elective outpatient treatment," Cuomo said.
But instead of lifting the ban statewide, he said he would take the same region-by-region approach the state will take as it looks to restart other parts of the economy and daily life shuttered amid the outbreak.
He said elective procedures won't restart in counties where Covid-19 remains a concern. This includes all of downstate and several upstate counties, including Erie and Albany.
In Erie County, Covid-19 hospitalizations reached an all-time high of 249 as of Sunday.
Hospitals in the counties where procedures are allowed to proceed must meet certain standards before they can go forward. If a county has fewer than 10 new coronavirus-related hospitalizations in the previous 10 days and if its hospital beds are at less than 75% capacity, then its hospitals can start offering elective procedures.
Ruffolo said he believes Niagara County will meet that threshold.
Niagara Falls Memorial staff will ask prospective patients to come in four days before their scheduled surgery to get a Covid-19 test that would reveal anyone who has the virus without showing symptoms. The hospital also will screen patients on the day of the procedure for a fever or any other sign of the virus, Ruffolo said.
Surgeons at Memorial typically perform about 160 elective, inpatient procedures per month. Combined with a drop in other patient visits, the hospital was forced to impose furloughs and pay cuts, Ruffolo said.
"Hopefully it enables us to start to recover some of the revenues we've lost over the past six weeks," he said.
Catholic Health is based in Buffalo but has one facility, Mount St. Mary's Hospital in Lewiston, in Niagara County. The hospital system plans to move ahead with procedures there, said CEO Mark Sullivan.
Monthly revenue has fallen by $45 million and surgeries have dropped from 1,040 to about 200 per week for the system.
Sullivan said he believes the system, which cares for Covid-19 patients at its St. Joseph Campus in Cheektowaga, can safely proceed with elective surgeries.
Excelsior Orthopaedics performs about 1,300 rotator-cuff surgeries, ACL repairs and other procedures in an average month but has seen its surgical volume fall by 90% as its physicians perform only emergency surgeries, CEO Dave Uba said.
Uba said some surgeons on staff perform procedures at Mount St. Mary's.
But he said it's disappointing for Excelsior and its Buffalo Surgery Center largely to be left out because the ban remains in place in Erie County.
The company has furloughed more than half its work force and its surgeons can't do what they're trained to do.
"People are in pain and we can't fix it," Uba said.
Kaleida Health, which has seen revenue fall by an estimated $30 million per month during the outbreak, said it is "eager" to learn more about the state's plan to resume health care operations.
Doctors performed about 200 elective procedures per week at Erie County Medical Center before the ban.
"This should be a thoughtful and informed process that protects the health and safety of both our patients and caregivers, as well as our broader community," said Thomas Quatroche Jr., ECMC's CEO and president.
Roswell Park CEO Candace Johnson, who was Cuomo's host Tuesday, was asked by reporters whether she was disappointed that the Erie County ban remained in place.
She said her larger concern is for cancer patients.
Mass testing, ideally in a form that returns results in as few as 10 minutes, would go a long way toward making patients and workers comfortable with resuming more medical treatments, Johnson said.
"Testing is key to that, so that they can come in through the doors, feel safe and get their cancer care taken care of," she said.