by Elizabeth Hofheinz, M.P.H., M.Ed., April 15, 2020
All things considered, ambulatory surgery centers (ASCs) are the new kids on the surgical block…the increasingly popular new kids.
In 1980, there were 275 ASCs in the U.S.1 As of March 18, 2020 there were 5,800.2
But given the Covid-19 crisis, will they have enough resources to survive? Or, conversely, will they thrive as safe havens for non-Covid care?
Katie Ford is Vice President of Physician Development at Surgery Partners, a nationwide operator of surgical facilities and ancillary services. “We are currently in a tough position,” Ford told OSN. “Our facilities are open and able to serve our communities, however, CMS put out a statement recommending that elective procedures be rescheduled or postponed. In addition, each local jurisdiction has released its own statement or recommendation also restricting elective procedures.”
“Our ASCs have staff and equipment, including any necessary PPE, but it seems like local governments are not putting a lot of strategic thought into its decision to restrict elective procedures. There are so many people in pain whose surgeries have been scheduled for months and all of a sudden, are told to postpone their procedures. But ASCs have the capability and supplies to handle these procedures.”
One door shuts…another one opens…
“These rulings impact us because ASC procedures are typically considered to be elective. While elective surgeries are not being done in hospitals due to the crisis, those that are emergent or elective theoretically can still be done in an ASC because these facilities are not treating Covid patients. We have extensive clinical protocols in place to ensure the safety of our colleagues, physicians, and patients. We have 16 surgical hospitals and 113 ASCs nationwide, with most operating at minimum capacity. Some doctors are saying, ‘We can’t go to the hospitals right now, can we do our surgeries at your ASC?’”
“We have been engaged with our local governments, health systems, as well as the federal government in order to make all groups aware of our position and availability to serve. We formed a Surgery Partners Task Force at the initial onset of this pandemic and have collaboratively developed strategies across all facets of the organization to offer solutions and continue to support our physicians, facilities, communities, and colleagues during this crisis.”
And while it is clear that some small business may never recover from the Covid crisis, Ford says that they have the resources in place to pivot and rebuild. “Quarter 3 is ramping up…quarter 4 is going to be even busier than usual.”
Hospital? Why would I go to a hospital?
“I think we are going to see a shift in the way patients and doctors think of hospitals,” says Ford. “They will ultimately be thought of primarily as places for emergencies.”
“As Medicare has approved more and more procedures for ASCs, the transition has historically been more market-driven. You will see a lot of orthopedic surgeons doing total knees in, for example, California and South Florida where markets tend to be more progressive. However, as hospitals continue to treat patients from this pandemic for months to come, it will likely expedite the shift in all markets moving more spine, orthopedic, and cardiac cases to ASCs.”
One such area of growth is the Rothman Orthopaedic Institute. With 10 ASCs and two more being built, that institution is poised to ride out the storm.
Alexander Vaccaro, M.D., Ph.D., M.B.A., is President of the Rothman Orthopaedic Institute and Chairman of Orthopaedics at Thomas Jefferson University headquartered in Philadelphia. He told OSN, “The way that ASCs are going to survive is to first have their staff take vacation time, then use their paid time off, and then go to flex hours. It is also helpful if an ASC has an agreement with a healthcare system to do emergencies and semi urgent cases. That way they can repurpose and rebrand themselves for the community. They need to eliminate any particular specialty designation by asking the state for leniency as far as licensure. We have the capability now to do am testing for the virus before a procedure to further protect medical care providers. The staff can work in shifts to care for volume as it increases and do whatever it takes to keep Covid-19 out of their facility.”
“By instituting these measures, ASCs can completely pivot their operations within 24 hours. That is critical because most such facilities only have 3-4 weeks of cash on hand.”
ASCs can be like a speedboat…instead of an ocean liner
Frank Phillips, M.D. is Professor and Director, Section of Minimally Invasive Spine Surgery, and Director of the Division of Spine Surgery at Rush University Medical Center in Chicago.
“Local ASCs are not faring well at the moment. The state has indicated that surgeons can only perform emergency surgery so as not to divert resources from the Covid battle. I do think that will shift, however, and ASCs will ultimately be the safety valve for elective surgery. As the system gets back to normal, they will be more capable than hospitals of reacting quickly. With hospitals, even if they set a date for restarting elective procedures, hospital ORs can’t just flip a switch and have a full schedule the next day…but ASCs can.”
Hospitals will be haunted by images on nightly news
And we might see increased ASCs activities, notes Dr. Phillips. “I think most patients would feel more comfortable going to an ASC—where there has been no Covid. The fact is that hospitals are going to have to contend with the lingering effects of this disease.”
“Part of any ASC recovery depends on payors and to what extent they are on board with expanding ASC procedures and providing appropriate reimbursement for more complex out-patient procedures. CMS has started enacting some of these measures that are favorable to ASCs, and I would hope that private payors will follow suit.”
“For now, with essentially no revenue coming in, most ASCs are just treading water.”
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