5 ways COVID-19 affected ASCs in 2020

The COVID-19 pandemic made 2020 a tumultuous year for ASCs, from restrictions on non-essential surgery to staffing and supply constraints.

Five major ways COVID-19 affected ASCs in 2020:

1. Operational restrictions devastated volumes, finances. Mandates to suspend non-essential surgeries amid initial COVID-19 surges in mid-March caused widespread, weeks-long ASC closures. The financial ramifications have been severe. For most ASCs, forgoing non-emergency cases meant missing out on a major portion of revenue. Some ASCs and physician practices were forced to close. Others survived using federal relief from the Coronavirus Aid, Relief and Economic Security Act, as well as ongoing guidance from the Ambulatory Surgery Center Association and specialty-specific societies. Clinically, shutdowns caused serious concerns about patient needs not being met. For instance, nearly 200,000 Americans have missed their colonoscopies this year, according to AmSurg, the ambulatory division of Nashville, Tenn.-based Envision Healthcare.

Surgery centers were largely able to reopen and recapture most volume by mid-summer, operating extended hours to work through backlogs. However, COVID-19 spread by alarming rates and hospitalizations led to more rounds of elective surgery restrictions in the back half of the year. This tumultuous healthcare environment was the last straw for a number of providers — a Medscape survey conducted in the summer revealed 25 percent of U.S. physicians were considering retiring earlier than previously planned because of their experiences with treating COVID-19.

2. Administrators worked through various staffing challenges. ASCs responded to early closures with drastic workforce changes in the form of furloughs, layoffs, pay cuts and hourly reductions. Ambulatory health services had the largest declines in employment in four metropolitan areas from February to April, according to a Kaiser Family Foundation analysis of U.S. Bureau of Labor Statistics data.

Reopening came with even more workforce challenges. Staff had to be "right-sized" for backlogs of delayed cases, and ASCs were tasked with keeping staff safe from COVID-19 exposure — one positive case could cause a domino effect of isolation and quarantine among staff, possibly to an extent necessitating closure. It was also important to maintain open lines of communication so employees would feel comfortable coming in to work. Still, some workers had to scale back hours to take care of children now at home and attending school virtually, or because of vulnerability to COVID-19.

3. Surgery centers assumed new, expanded roles. On March 30, CMS' unveiled its "Hospitals Without Walls" initiative, which allows hospitals to provide inpatient care in enrolled ASCs and other temporary expansion sites for the duration of the COVID-19 public health crisis. There were 85 ASCs participating in the program by late November, when CMS announced an update regarding staffing: ASCs enrolled as hospitals are not required to provide 24-hour nursing services unless one or more patient is receiving care on site.

Throughout the pandemic, ASCs have also found other ways to assist relief efforts. Some, including Lubbock-Texas based Covenant High Plains Surgery Center, introduced COVID-19 testing capabilities. Others sent staff to COVID-19 hot spots or donated personal protective equipment that was going unused during elective surgery limitations. The New Jersey Association of Ambulatory Surgery Centers, for instance, provided the state health department information on the types and quantity of PPE stockpiled at all the state's ASCs — not just NJAASC members.

4. A transformation of protocols took place. Entering an ASC at the end of 2020 looks much different than it did at the beginning of the year. Many centers established committees to develop and regularly assess new policies as the medical community learns more about COVID-19, and as infection rates fluctuate. Plexiglass shields at front desks and sanitizer stations throughout facilities are now a familiar sight. Visitor restrictions have been implemented, lifted, and re-implemented, new infection prevention technology has been installed, and centers have adopted individual protocols for COVID-19 screening and testing in accordance with state and local requirements.

Additionally, the pandemic affected daily operating room management, particularly for surgical procedures that cause aerosol production, according to a narrative review published in the September issue of the Journal of Clinical Anesthesia. Many of these changes required a greater time commitment by staff and a greater investment in single-use supplies than centers may have originally budgeted for.

5. Outpatient migration picked up even more speed. The COVID-19 pandemic has changed how patients seek care and perceive hospitals, several reports and experts say. While clinicians have always known the value of ASCs, the general public has just now begun to learn of the benefits, according to Nader Samii, CEO of National Medical Billing Services. "We're seeing a bigger [amount of] patient driver now than ever before," he said during a June 25 webinar. In 2005, 32 percent of surgeries were done in ASCs; that has increased to nearly 60 percent in 2020, with no signs of stopping, Mr. Samii said.

Released in early December, CMS' 2021 payment update for ASCs reflected continued payer interest in migrating procedures to the outpatient setting. The agency finalized plans to remove 1,700 procedures from the inpatient-only list by 2024, and to add 267 codes to the ASC-payable list beginning Jan. 1, 2021. These decisions will further expand opportunities for ASCs, where the risk of infection — COVID-19 included — is lower than it is in a hospital, making it an appealing setting for patients who are now more infection-conscious than ever.

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