Hospitals across the United States are once again setting aside their elective surgeries as COVID makes another surge across the globe. As this plays out, many hospitals are returning to the early days of the pandemic when such procedures were canceled and postponed to ensure health systems could maintain their employee resources and hospitals took steps to reduce the spread of the virus.

Elective surgery or an elective procedure is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery must be done to preserve the patient's life but does not need to be performed immediately.

Elective procedures — like knee or hip replacements — can typically be delayed but are the most lucrative for systems. Pushing against their need to balance their bottom lines and keep their patients and staff healthy, the decision to delay many of these procedures is returning.

Some Mayo Clinic outposts are forgoing elective surgeries for the time being to free up beds for COVID-19 patients.

Cleveland Clinic is taking similar action as it sees cases of COVID spike. It started rolling back elective procedures in November.

Other hospital systems, including Oregon Health & Sciences University and Kaiser Permanente Northwest, are instituting new limits on elective surgeries because of new COVID cases.

Legacy Health, which operates Legacy Good Samaritan and Legacy Emanuel medical centers in Portland, will reduce elective surgeries requiring a hospital stay by 25%. Outpatient procedures are not impacted.

“We will monitor the situation and adjust as needed,” Trent Green, the chief operating officer, wrote in an email to doctors and staff Wednesday. “If the number of hospitalized patients continues to grow, we may cancel more surgeries. As hospital volumes lower, we will add back elective surgeries.”

In Michigan, Ascension Genesys hospital told its medical staff not to schedule new elective surgeries until at least Nov. 30 amid a surge in COVID-19 cases.

Similar stories are playing out elsewhere.

Travel nurse staffing firm Aya Healthcare reported a 57% increase in demand for travel nurses earlier this month and said open "crisis nursing" positions increased 291%.

Systems are individually planning how they'll restart electives when surges eventually wane.

Despite the second occurrence of elective procedures grinding to a halt, other practices made popular by the pandemic are getting a second chance at securing a foothold in service to patients. For example, virtual care platforms that consumers took a liking to out of convenience because of the pandemic shutdown.

Based on six consumer surveys with 500 respondents each and taken every month from April to September, a Kaufman Hall report shows that new virtual tools are increasingly popular with patients.

Consumers are still mainly turning to virtual visits, though less so than peak levels witnessed this spring. However, a permanent shift toward more virtual visits poses a challenge for providers planning their future service mix while trying to recoup lost revenues.

Providers must plan for possibly lower payments on telehealth visits if CMS rolls back pandemic-related waivers to reimburse for those services, the Kaufman Hall report warned.

Patients want their caregivers to provide care virtual and in-person. Other factors patients consider essential are scheduling visits online and paying their bills via a secure portal.

So, while hospitals shutter some services to respond to COVID, patients are likely in a better position now than at the start of the pandemic to receive care and treatment virtually, unlike, perhaps, in March 2020.