9 steps practices are taking to reopen — seeking financial aid, winning patients' trust & more

Suffering blows to their finances, staffing and normal business models, ASCs are preparing to reopen for patients as nearly two dozen states ease restrictions on elective surgeries.

Nine steps surgery centers and specialty practices are taking to resume operations:

1. Seeking financial help. Olympic Anesthesia in Bremerton, Wash., was among the practices that applied to receive a federal small business loan offered through the Coronavirus Aid, Relief and Economic Security Act's Payroll Protection Program. ASCs are also getting support at the local level. Wyomissing, Pa.-based Berks Ambulatory Surgery Center, for instance, received a $100,000 loan from the Pennsylvania Department of Community and Economic Development.

2. Prioritizing cases. Abilene-based Texas Midwest Surgery Center is rescheduling patients whose elective procedures were delayed and prioritizing cases based on medical needs. Topeka, Kan.-based Stormont Vail Health is also restarting some elective cases, but it will continue to delay surgeries for patients with heart disease, lung disease or diabetes, as well as patients over 65 years old.

3. Easing into it. The California Society of Anesthesiologists and the California Ambulatory Surgery Association endorsed a "step-wise" approach to resuming cases, and centers are listening. Stormont Vail Health will begin performing elective surgical procedures May 4, with its clinics and surgery centers set to operate at 50 percent capacity. Sansum Clinic, an outpatient practice in Santa Barbara, Calif., also plans to restart procedures at half capacity in early May.

4. Screening and testing. All patients at Stormont Vail Health's two surgery centers will be tested for COVID-19 and must test negative before they can undergo a procedure. That's the case for many other ASCs following guidance from industry organizations, including North Mississippi Surgery Center in Tupelo and the surgery center owned by Beaumont, Texas-based Riceland Healthcare. Surgery Center of Aiken (S.C.) is asking patients to shelter in place during the period between getting tested and having their procedure.

5. Adjusting protocols. Patients and staff are asked to abide by social distancing guidelines within ASCs, many of which have implemented visitor restrictions. Some are requiring patients to wear surgical masks at all times, unless they're undergoing procedures that necessitate breathing tubes. These kinds of precautions are likely to become "the norm in all healthcare facilities," according to Benjamin Domb, MD, founder and medical director of the American Hip Institute & Orthopedic Specialists in Des Plaines, Ill.

6. Anticipating longer turnover times. At North Dallas Ear Nose & Throat, staff will be required to remain in the operating room for 15 minutes after each surgery is finished and the patient's breathing tube is removed. This measure is intended to give the micronized filtration system time to clean the air before the OR doors are opened. With other ASCs expecting slower turnover as they address backlogs, surgeons are preparing to work longer hours.

7. Winning patients' trust. Surgical groups are using Plexiglass and copper-infused surfaces to limit exposure to particles that spread COVID-19. Such precautions are important, according to Morris Gottlieb, MD, head of North Dallas Ear Nose & Throat, who said resuming elective surgeries at typical volumes will require showing the public it's safe to visit the facilities.

8. Adjusting staffing. Although many executives and physician leaders have taken pay cuts, finances are in dire shape for a number of surgery centers. This has led to furloughs, and in some cases, layoffs. As elective procedures return, ASCs must ensure the size of their workforce matches the volume of patients they're serving. Groups such as Beacon Orthopaedics & Sports Medicine in Sharonville, Ohio, are bringing furloughed employees back in "waves" based on how many patients get rescheduled. To ensure they have not just enough workers, but enough healthy workers, McKinley Orthopedics and Sports Medicine in Fairbanks, Alaska, will put staff on rotating schedules that incorporate "quarantine" time.

9. Assembling committees. In early April, the American College of Surgeons recommended that all organizations convene a surgical review committee to provide "defined, transparent and responsive oversight" and to "lead the development and implementation of guidelines that are fair, transparent and equitable." Sansum Clinic is one facility that has done so, forming a committee with surgeons, the surgery center medical director, anesthesiologists and administrative staff to determine how to best proceed with elective cases.

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