How a Texas endoscopy center is navigating the pandemic to stay open and independent

During the early months of the pandemic, when many ASCs temporarily closed, Wichita Falls (Texas) Endoscopy Center deepened its relationship with a local hospital to support the COVID-19 response and remained open to care for patients.

"When the pandemic started, our priorities initially were to make sure we were prepared with enough of an inventory for PPE and other supplies," said Louis Wilson, MD, a partner at Wichita Falls Endoscopy Center. "We were proactive way before the first cases came to Texas to make sure we had enough PPE. Then, the most important thing we did was coordinate closely with our local health system and we all agreed that the ASC was the best place to perform urgent care."

The health system and endoscopy center developed a structure for continuous communication. Representatives from the hospital and ASC administration as well as practice physicians meet regularly to discuss the effects of the pandemic, hospital capacity, PPE distribution and directives from the state and federal government to coordinate their response.

"Early on, we dealt with the daily constant flood of information, some of which was data-based, but much of which was not," said Dr. Wilson. "We decided to prevent the constant 'hallway talk' and instead have structured meetings twice per week where we could prepare and bring questions and slow down the processes so we could make decisions. Then we realized we only needed one meeting per week. We do the local and regional COVID-19 updates in those meetings and discuss any new business."

The organizations bring in experts to the meetings to discuss topics like infectious disease spread and COVID-19 testing criteria. They also look ahead to the next week and month schedules to make projections about what areas would most need PPE.

"It was very beneficial to slow things down, knowing that we couldn't make many of the daily changes in the moment anyway," said Jeremy Watkins, clinical manager of Wichita Falls Endoscopy Center. "I feel like it is stabilizing for our staff and patients as well."

Wichita Falls Endoscopy Center continued to schedule appointments for the future, which many ASCs stopped when they temporarily closed. Those centers, Dr. Wilson said, had a hard time bringing patients back when they reopened.

"For us, the scheduling never stopped. Referral sources weren't confused about whether we were open or not, and we communicated with all of our referral sources early on that we weren't closing," said Dr. Wilson. "We told them to keep making referrals and we'll keep scheduling. We just made the appointments for several months in the future for the colorectal cancer screenings. There is nobody more busy than the schedulers during the pandemic because there was so much shuffling around of appointments."

When cases slowed, the center reduced the surgeon blocks per week from four to one or two to maintain productivity and meaningful staff hours. Most staff members were willing to work as the virus spread as long as the center was cautious and used appropriate PPE and cleaning guidelines. Mr. Watkins also communicated with the team at weekly meetings to keep them updated on the current status of the practice.

Finally, Wichita Falls Endoscopy Center received Coronavirus Aid, Relief, and Economic Security Act financial aid from the federal government. Because the practice didn't shut down or furlough staff, as other surgical groups did, they were able to participate. The PPP loans, which were part of the CARES Act funding, stipulated that organizations had to retain 75 percent of their staff to receive the loans.

"Some centers were running such tight margins and they panicked and furloughed everybody, and that is alarming," said Dr. Wilson. "It's concerning for centers to not have enough cash on hand to run 90 or 120 days if needed. That's critical."

In the future, Dr. Wilson said the group will be even more conservative about purchases and making sure they're debt free. He also says making sure the center has adequate resources to respond to any catastrophe will be a top priority going forward.

"The way 2020 is going, we are waiting for space aliens to hit," said Dr. Wilson. "When you are dealing with risks, it's always in the books you haven’t read yet. We don't know what the next thing will be. But we will remain independent and foster what has worked for us in terms of strong communication with the health system, mutual trust and independence."

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