The state of ASCs in June 2020: 10 observations on supply chain, payers, staffing & future growth

The pandemic is having a lasting impact on the ASC space, which could result in growth over the coming months.

Here are 10 observations for surgery center owners and operators from the Becker's Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Virtual Event, which was held June 17-19. Click here to view the panels and session on-demand.

1. ASCs continue to face PPE challenges and are finding new and creative ways to access masks, gloves and other essential materials. Some are also keeping masks, wipes and gloves under lock and key as some have reported staff and patients attempting to remove PPE and sterilization materials from their centers.

2. Prices for PPE, sterilization, lubrication and pharmaceuticals are all increasing during the pandemic. Many are more in demand than ever and some face shortages. The FDA put 28 drugs on the shortage list for the first time during the pandemic. ASC administrators are placing orders as soon as they find materials to avoid further price increases.

3. The pandemic has forced many ASC administrators to re-think previous policies of minimal ordering for supplies to make sure they have enough PPE and other supplies to continue running in the coming months if there are further shortages and additional surges of COVID-19 in their communities.

4. Patients are now requesting surgery be done at the ASC so they don't need to go into the hospital, and would prefer not to stay overnight in the hospital if possible. In some cases, ASCs are taking on more cases to fill the needs of patients who had cases delayed during the pandemic who want or need treatment but are uncomfortable with the hospital setting.

5. It is becoming increasingly important to control all aspects of the orthopedic surgical episode, especially for total joints as they move toward risk-based contracts and bundled payments. Now, surgeons and ASCs are looking into growth by aligning with physical therapy, imaging, telehealth and remote patient monitoring capabilities to ensure the right level of care and cost-effectiveness.

6. The PPP and Small Business Association loans were extremely helpful for ASCs and practices that limited elective surgeries during the pandemic. Some centers and practices also received payment from payers on all of their backlogged claims shortly after the pandemic was announced, which also helped them financially until they were able to resume more normal operations.

7. Staffing during the pandemic has been a key concern. ASCs and practices that furloughed staff are now looking to bring them back, and in some cases staff members want to stay on reduced hours to spend more time with their children; others don't feel safe returning to the center because they are at high risk of contracting the virus. ASCs have had to become creative with staffing, and in some cases are giving more hours to per diem staff who are requesting more due to the lack of work during the pandemic.

8. Many, but not all, ASCs are requiring patients to take COVID-19 tests prior to surgery and then self-quarantining until surgery. When patients test positive for COVID-19, their procedures are often postponed. ASCs are also experiencing postponed surgeries or cancelations from patients if they wake up with a cough or not feeling well the day of surgery.

9. Staff are less likely to come in to work if they have a cough or are not feeling well whereas in the past they might have decided to "power through it" and still come to work. This may mean the need for more flexibility and per diem staff in the future.

10. Surgeons affiliated with ASCs are seeing more interest in them by their colleagues who don't currently perform cases there because the centers can accommodate them and patients are seeking outpatient options. Payers are also seeing the benefit of ASCs as they take on higher acuity cases and could be more open to partnerships in the future.


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