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Scoring System Could Help Cash-strapped Hospitals Move Forward With Some Surgeries

Analysis  |  By Alexandra Wilson Pecci  
   April 15, 2020

University of Chicago surgeons have been using the new Medically Necessary Time-Sensitive Prioritization process for about two weeks, and have increased the number of medically necessary, time-sensitive operations to about 15 per day.

A new scoring system aims to help surgeons across surgical specialties decide when to proceed with medically necessary operations that might have otherwise been postponed because of the COVID-19 crisis.

Investigators from the University of Chicago detailed the new Medically Necessary Time-Sensitive (MeNTS) Prioritization process in an "article in press" on the Journal of the American College of Surgeons website ahead of print.

For cash-strapped hospitals, mass cancelations of scheduled surgeries means they're taking a massive financial hit.

"Elective surgeries are often more profitable cases for hospitals and health systems," says Ric Sinclair, chief strategy and product officer at Waystar. "This will impact their bottom line."

University of Chicago surgeons have been using MeNTS for about two weeks, and they have increased the number of medically necessary, time-sensitive operations to about 15 per day, according to the American College of Surgeons.

The new methodology addresses some of the so-called "elective" surgical procedures that lack good nonsurgical treatment options and may cause additional problems and complications if they're delayed.

"Although we talk about these operations as being 'elective,' that doesn't mean they are optional. It's just a matter of the surgeon and the patient having the opportunity to elect the time when the operation should take place," Vivek N. Prachand, MD, FACS, lead author of the article, and professor of surgery and chief quality officer at University of Chicago Medicine and Biological Sciences, said in a statement. "The procedures are more aptly called medically-necessary and time-sensitive."

A team of six representatives from general surgery, vascular surgery, surgical oncology, transplantation, cardiac surgery, otolaryngology, and surgical ethics created the new MeNTS Prioritization process.

They reviewed studies of the effect of COVID-19 as well as severe acute respiratory syndrome on hospital resources, healthcare providers, surgical procedures, and surgical patients in Asia and Europe and identified 21 factors related to outcome, risk of viral transmission to healthcare professional, and use of resources.

Each of the 21 factors is scored on a scale of 1 to 5, and the total score, ranging from 21 to 105, is computed for each case. The higher the score, the greater the risk to the patient, the higher the utilization of healthcare resources, and the higher the chance of viral exposure to the healthcare team.

The researchers say that MeNTS may be used by any facility that is performing medically necessary, time-sensitive operations and can be applied anywhere, regardless of the location and size of the facility.

"The factors are not hospital- or practice-environment-specific. These factors are fundamental and straightforward and can help surgeons and hospitals provide the surgical care that patients need both now in the thick of the pandemic as well as when we get to the other side of the peak," Prachand said.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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