A model for the nation: New York ASCs prepare to play direct role in COVID-19 relief

In a state where cases of COVID-19 are doubling nearly every three days, the New York State Association of Ambulatory Surgery Centers is regularly communicating with its roughly 80 members to offer guidance, resources and leadership through the crisis.

Circumstances surrounding the novel coronavirus pandemic have evolved rapidly. About two weeks ago, NYSAASC was relaying the CDC's initial screening guidelines to its centers. That guidance escalated to higher levels of screening. Then, about a week ago, NYSAASC echoed recommendations from the American College of Surgeons, the U.S. surgeon general, the Ambulatory Surgery Center Association and others, urging facilities to postpone elective cases.

Even that protocol changed in just a matter of days. On March 22, New York Gov. Andrew Cuomo announced an executive order that made postponing elective procedures more than a recommendation — it's now a mandate across the state. Healthcare providers are also required to establish policies and protocols for evaluating which cases to move forward with.

With ASC case volumes down significantly, NYSAASC President Jon Van Valkenburg estimated that about half of the society's member centers have temporarily closed. The others are operating with limited services. The single-specialty orthopedic surgery center that Mr. Van Valkenburg runs, for instance, is providing treatment for conditions such as fractures.

As operations slow down for surgery centers, they're working to determine where they can help beleaguered hospital counterparts that are bracing for patient surges and critical supply shortages.

On March 23, New York hospitals were directed to increase their bed capacity by at least 50 percent — but ideally 100 percent — and to submit a plan for doing so. Since then, Mr. Van Valkenburg has been getting more calls.

"Now, we're having hospitals and health systems reach out to us and say, 'This is an ambitious thing we have to do. If we're going to increase capacity by 100 percent, how do we utilize some relationships or agreements we can develop with surgery centers?'"

Kaleida Health in Buffalo, N.Y., is one system that has already publicly asked hospitals to utilize ASC capacity for COVID-19 patients. By adding intensive care beds, converting space and relying on ASCs, the system could increase bed capacity by as much as 50 percent. Rome (N.Y.) Memorial Hospital also aims to increase capacity by 50 percent and is in talks with Rome-based Griffiss Surgery Center to make it happen.

For hospitals still ironing out the best way to utilize local centers, another possibility is turning surgery centers into childbirth facilities for healthy mothers, Mr. Van Valkenburg said. This strategy could free hospitals to repurpose obstetrics units for COVID-19 patients. But to use surgery centers for extra capacity and other purposes, there would need to be changes.

For starters, surgery centers may need additional equipment to accommodate services that are typically hospital-based, and they're subject to 24-hour stay requirements in New York. There are also questions regarding proper allocation of staff, should surgery centers begin accommodating hospital patients.

The New York health commissioner has requested CMS approval to waive a slew of general healthcare requirements, but as of yet, none are specific to surgery centers, according to Mr. Van Valkenburg.

With New York authorities "preparing to do whatever needs to be done," it's important to make sure changes are made in a coordinated way, he said. As he fields calls from hospitals asking how many anesthesia machines the state's ASCs have available, Mr. Van Valkenburg is worried that resources could be double-counted if allocation isn't managed properly.

What's promising amid all of this, he said, is the "unprecedented" level of communication among ASCs. Mr. Van Valkenburg has confidence that the members in NYASCA are prepared to step up, and he's been in touch with at least one in New York City that's being turned into a COVID-19 testing center.

While empty ASCs may mean more space for COVID-19 patients, they reflect financial hardship for the centers themselves. Many groups have had to furlough staff, Mr. Van Valkenburg said. But he doesn't think they'll be defeated in the long run.

"ASCs are well-positioned to bounce back. There is potential that some of these temporary changes might actually lead to some long-term changes," he said, noting that long-term projections are purely speculative at this stage. "If ASCs are being used temporarily [in new ways], it might present an opportunity for ASCs to expand offerings and services in the long term as well."

While New York ASCs pivot and await coordinated directives from the governor and health authorities, the country is closely watching how New York handles the pandemic.

"It's not happening only here; it's happening here first," Mr. Van Valkenburg said. "Hopefully, the things we do … can help other states as this spreads throughout the country."

Are you an ASC owner, administrator or employee? Email Angie Stewart to tell us how the COVID-19 pandemic is affecting your center: astewart@beckershealthcare.com.

More articles on ASCs:
Nebraska ASC plans for higher volumes — 5 things to know
Kentucky halts elective medical procedures — 3 insights
Tennessee governor orders ASCs to halt elective surgery, donate PPE: 4 notes

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