The 'new normal' for ASCs: 16 admins on how the pandemic will change the field forever

Sixteen ASC administrators project what the "new normal" will be at their centers as a result of the pandemic.

Alfonso del Granado. Administrator of Covenant High Plains Surgery Center (Lubbock, Texas): It’s really hard to say what the 'new normal' will be for the long term, though I expect the eventual widespread availability of vaccines, herd immunity, and human apathy will put pressure on the system and tip the balance back closer to efficiency versus safety. In the interim, expect continuing PPE-preservation measures, including CDC guidelines for extended- and re-use of N95 masks, as well as decontamination measures recommended by the recent NIH study.

We also expect ongoing restrictions on patient family members as well as OR visitors and observers. We are now considering allowing students back so long as they are tested regularly and we have enough PPE, but we expect that to relax more as things stabilize. We are acutely aware of the likelihood of a resurgence, both seasonal as well as due to human behavior, so we are remaining cautious, but also cautiously optimistic.

As challenging as this crisis has been, it has also shown the resilience of organizations prepared to deal with the unexpected. This has been a growing trend over the years, as the healthcare landscape changes more and more rapidly, and COVID-19 has just been the latest, though most severe test of that ability to anticipate and adapt. More than ever, ASCs need to continually grow and improve in order to succeed.

Leticia Ramirez, RN, BSN. Administrator of MidAmerica Orthopaedcis (Palos Hills, Ill.): Our new normal is very questionable. We are anticipating not being able to get testing supplies, labs being too busy to meet the 72 hour turnaround, and patients that have recovered from COVID testing positive for months, whether or not they were aware of their infection, which takes away from our business. Hospitals aren't even willing to work with ASCs for testing unless the procedures are performed at their facilities. ASCs are set up to fail.

Polly Ladd. Administrator of Crowne Point Endoscopy & Surgery Center (Flint, Mich.): It looks like slower schedules, decrease in productivity, and increase in PPE! Expenses will increase and revenue will decrease, it is going to be imperative to look at ways to be more cost effective than ever. Safety is and has always been our number one priority and that won't change, but the flexibility we had with paying staff more due to our revenue base and being so efficient, will definitely be greatly impacted. It's going to be a day-by-day adjustment and it will take some time to find that 'new normal.'

Raghu Reddy. Executive Administrator of SurgCenter of Western Maryland (Cumberland, Md.): The new normal for us will be to adapt to new work schedules, limit the number of people in the building, everyone requiring a face mask while in the center and ensuring that we operate with heightened caution and pace ourselves to perform these cases safely. These are even more important when we start performing cases where an airway is involved, and extra protections are in place for our staff and anesthesia providers.

The N95 masks, along with face shields and gowns, are necessary for everyone close to the airway, and any shortage in PPEs and N95 masks will limit what we can do at the center. From the business perspective, it is going to be challenging for a while to manage the accounts payable or any short liabilities until this pandemic slows down, and the RCM becomes normal. A great deal of anticipation and careful planning should be in place for us. Still, the execution is critical to safely care for our patients while coordinating with the local hospital and limiting the spread in the community.

Matthew Ewasko. Administrator of Physicians Alliance Surgery Center (Cape Girardeau, Mo.): We are looking at keeping some of the processes that we currently have in place, and looking at what steps can be taken to improve should we experience something like this again. One of the items we are going to keep is our check-in process for sales reps at the facility. This will allow us to track who is in our building with greater efficiency, and allow us to limit the amount of personnel in our surgical suites.

One process that we will start focusing more on is the utilization of available technology. Using some of the available tools and resources out in the market will enable our processes to streamline and reduce the amount of direct patient contacts. We are looking at paperless registration processes, integrated scheduling with our physicians' offices, and improving upon our billing procedures.

Another key aspect that we have learned during these past few weeks is that we need to improve our preparedness in regards to supply items. While we were, and are, well stocked on normal use items, we did not have a plan for increased protection PPE items since those items weren't historically used at our facility. A list of needed items will be developed, and a new stock area will be created for these items to be stored in case of future need.

Rick Liwang, RN. Administrator of Gulf Coast Outpatient Surgery Center (Biloxi, Miss.): We ask for a lot of patience and understanding from the staff, the patients and the doctors as this pandemic has us ever-changing and ever-evolving in our protocols and procedures. Our scheduling pattern has changed. Our one visitor per patient protocol has been included in our policy. Our screening policy has changed and most importantly, we now are versed with our pandemic protocols, which we did not highlight as much as we are doing it in real time.

Bonnie Brady Lavoie, RN. Vice President of Operations for West Morris Surgery Center (Succasunna, N.J.): The new normal will include a much more detailed look at inventory especially PPE and what our needs will be. Vendors and salespeople needing gowns and masks will no longer be allowed to the extent they have been. We will need to stay on top of new infection control guidelines to see where we can conserve and what is likely to be reused.

Bobbi Freeman, RN. Gastroenterology Endoscopy & GI Lab Manager of Harbin Clinic Endoscopy Center (Rome, Ga.): We are trying very hard to get back to 'business as usual' but the unusual circumstances of this pandemic are making that very difficult. As long as we do not have COVID-19 positive exposure or potential exposure, I feel like we will be able to continue to keep our center open for urgent and semi-urgent endoscopic procedures.

Hopefully we will be able to perform routine endoscopies by the late summer or fall. Of course, this is all subjective. A good analogy that I have heard with relation to how healthcare workers are having to deal with this COVID-19 pandemic is like trying to change the tire on a bus that is driving down the road. I think that sums it up pretty accurately.

Michelle Eilander, RN. Administrator of Ankeny (Iowa) Medical Park Surgery Center: We have always put safety first, for both patients and employees. So the new normal will continue to look at ways to keep safety our No. 1 priority. Flexibility is key in this ever-changing environment and we will change processes and protocols as needed to ensure the safety of everyone. I truly believe that people will feel more comfortable coming to an ASC over a hospital and we will see an increase in cases going forward.

Catherine Retzbach, RN, BSN. Administrator of Memorial Ambulatory Surgery Center (Mount Holly, N.J.): Hopefully the new normal will be an increase in cases in the outpatient setting since it is a more cost effective and safe environment. The hospitals will still be dealing with viruses for an extended period of time so the ASCs will offer an alternative site to perform cases.

Tracey Tylicki, RN, BSN. Administrator of Carolina Coast Surgery Center (Murrells Inlet, S.C.): I believe the value of elective surgeries in an ASC will be at the forefront as patients become more concerned about infection control practices. We are seeing that now where patients are asking for their cases at the ASC versus gong to a hospital. That is wonderful news for the ASC environment as we have always shown that ASCs provide quality care with lower infection rates as well as excellent customer service while simultaneously reducing costs.

John Lewis. CEO of Semmes Murphey Clinic (Memphis, Tenn.): Although we have experienced some real challenges these last few weeks, I thinks it's important to look for positives in situations like these. Everything we've learned during this time is so valuable and will impact our new normal. This event has pushed us to grow even more responsive, innovative and resourceful so that we can continue to provide medical care when and where it's needed.

Patricia Frendak, RN, BSN. Administrative Director of New Britain Surgery Center: The new normal will include additional screening for patients, allowing more time between cases, additional costs for additional layers of PPE for the staff.

Debra Hagendorn. Administrator of East Hills Surgery Center (Greenvale, N.Y.): I'm not sure yet. Patients will be hesitant to go to hospitals for elective procedures because the fear of COVID-19 will be present for quite a while. ASCs can provide the high quality care for these patients. Due to PPE use by staff, surgeons, etc., it will be very important for patients to still feel a personal touch as part of their surgical experience. Issues will evolve as we move forward that will determine what our new normal will be like.

Todd Currier. Administrator of Northern Wyoming Surgical Center (Cody): I foresee we continue to closely monitor our patient population, require additional PPE supplies on hand throughout the remainder of this year, we prepare for a possible resurgence in the fall, and we also maintain a higher cash position to withstand possible future issues.

Barbara Smith. Administrator of Multi-Specialty Surgery Center (Va.): All of my staff will be tested for the virus, (standard of this community). They will have their temperature taken every morning. We will initially limit the number of family who can accompany the patient to one person. We will try to not have children in the waiting room. We only do ages 18 and above. I may regularly have our reception area, Pre-Op/PACU area terminally cleaned.

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