out of equipment and supplies , loss of staff , anesthesia providers moving to the hospitals for intubations , among many other things ,” Link says . “ There was a complete shutdown in ASCs because cases were elective , but this did not happen in inpatient settings which continued to do emergent cases . In the future I anticipate that there will be a quicker move to do outpatient surgery for urgent and emergent cases that do not require an overnight bed . We have seen poor outcomes for those procedures which were delayed , both in quality of life and health and I think this will be taken into consideration should another shutdown become necessary and become part of the plan up front .”
As Prentice acknowledges , “ In the early days of the pandemic , of course , there were a lot of unknowns . At first , no one was entirely certain how the virus was transmitted and hospitals that were inundated with coronavirus patients and other healthcare facilities were concerned about having adequate personal protective equipment ( PPE ) supplies for their staff . Out of an abundance of caution , and to conserve PPE , there was a period when a number of states asked ASCs to suspend all elective procedures . Typically , those suspensions lasted only a few weeks , but for those facilities that closed completely during that time , reopening was a complicated process that required extensive checking of supplies and sterile conditions . Like hospitals , ASCs also encountered supply shortages and complicated staffing issues as many members of their staff were also needed at home to care for their families during that time .”
Prentice continues , “ Fortunately , ASCs are small businesses that can respond rapidly to change , so after the states dropped their temporary suspensions , ASCs were up and running within a week or two . Many were prepared to help hospitals provide outpatient surgical care to patients they could not accommodate while struggling to provide services to large numbers of coronavirus patients . After consulting with clinical experts in the healthcare community , ASCA published a statement in mid-March asserting that ASCs could and should remain open during the pandemic . The association also worked with members of Congress , the White House , and federal regulatory officials to help remove barriers to patient access to the care ASCs could provide .”
Throughout 2020 during the brunt of the pandemic , ASCA worked with Congress , the White House and other federal officials to support ASCs and ASC physicians . As Taira ( 2021 ) explained , “ ASCA advocated strongly for quick resumption of elective surgeries in states where capacity allowed , educating lawmakers and regulators that ‘ elective ’ does not mean unnecessary and that delays on procedures such as colonoscopies can be detrimental to patients . ASCA also ensured that valuable , pandemic-related financial relief programs such as the Paycheck Protection Program , Provider Relief Fund and Accelerated and Advanced Payment Program funds were made available to ASCs .”
Proving that ASCs could provide quality care during the pandemic without contributing to the national COVID-19 caseload , would come down to following evidence-based practices . To help outpatient facilities comply , in mid-March 2020 ASCA issued a
statement outlining the precautions being taken and clarifying some conflicting guidance about elective surgeries .
ASCA consulted with clinical experts in its community and stated that , “ ASCs can continue to provide safe surgical care for patients whose condition cannot wait until hospitals return to normal operations . As a critical component of the healthcare system , we are keenly aware of how our actions can materially impact the health of the communities that we serve …”
To that end , ASCA issued guidelines for the continuation of urgent / needed care in ASCs :
1Assessing and optimizing patients ’ medical and social risk factors for planned surgeries , and postponing cases where indicated , including :
● Reassessing and reprioritizing all currently scheduled cases and postponing based on the current and projected COVID-19 cases in the facility and the surrounding area and when doing so will not result in significant medical deterioration or materially impact the patient ’ s prognosis , morbidity or treatment plan
● Acknowledging that every patient encounter is unique and postponement decisions must represent a joint decision between the treating clinician and the patient
● Implementing rigorous screening for patients and visitors prior to entering the facility
● Maintaining a safe environment for patients , employees and visitors , including adherence to social distancing recommendations
● Implementing enhanced cleaning as directed by CDC guidelines
● Working within the capacity of the supply chain to ensure that hospitals have priority for necessary equipment / supplies
● Collaborating with hospitals and health systems to coordinate care based on each community ’ s individual needs
As we know , within the larger healthcare community , in March 2020 , the Centers for Medicare & Medicaid Services ( CMS ) acknowledged that the COVID-19 pandemic represented an “ unprecedented public health emergency ” and that healthcare facilities in some areas were stretched to their limits of capacity . Surge areas were needed to augment care for patients with COVID-19 , expand capacity to care for these patients , and conserve adequate staff and supplies , especially personal protective equipment ( PPE ), CMS recommended limiting non-essential care and expanding surge capacity into ambulatory surgical centers and other areas .
In April 2020 , however , CMS recognized that , “ At this time many areas have a low , or relatively low and stable incidence of COVID-19 , and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent , non-COVID-19 healthcare . In addition , as states and localities begin to stabilize , it is important to restart care that is currently being postponed , such as certain procedural care ( surgeries and procedures ), chronic disease care , and , ultimately , preventive care . Patients continue to have ongoing healthcare needs that are currently being deferred . Therefore , if states or regions have passed the Gating Criteria ( symptoms , cases , and hospitals ) announced on April 16 , 2020 , then they may proceed to Phase I .”
CMS had also encouraged maximum use of all telehealth modalities ; however , for care that could not be accomplished virtually , the agency ’ s Phase 1 recommendations were designed to guide healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with low incidence of COVID-19 disease .