Although we all hope that we do not experience another pandemic , patients and employees will benefit from policies and plans that came about over the last year .
The written disaster preparedness plans that have been revised during the pandemic will serve centers well going into the future .”
— Kathy Wilson
suggested starting point in the preoperative evaluation of the COVID-19-recovered patient .”
The timing of elective surgery after recovery from COVID-19 utilizes both symptom- and severity-based categories . Suggested wait times from the date of COVID-19 diagnosis to surgery are :
● Four weeks for an asymptomatic patient or recovery from only mild , non-respiratory symptoms .
● Six weeks for a symptomatic patient ( e . g ., cough , dyspnea ) who did not require hospitalization .
● Eight to 10 weeks for a symptomatic patient who is diabetic , immunocompromised , or hospitalized .
● Twelve weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection .
The Fiscal Impact of COVID-19 on ASCs , A Future Shift , and Lessons Learned
Clinical concerns aside , the pandemic is leaving a last footprint on facilities ’ finances . COVID-19 inflicted significant damage to healthcare facilities ’ bottom lines across the delivery spectrum , and not all sectors are expected to return to pre-pandemic levels . A brighter forecast issued by Vizient , Inc . and its subsidiary company Sg2 released earlier this year projects a rapid recovery of volumes for most services as COVID-19 abates , followed by a seismic shift in healthcare delivery as services move from hospitals to other care facilities .
ASCA ’ s Bill Prentice says that this shift is aided by the growing sophistication of outpatient facilities and their ability to handle increased patient acuity levels . “ Over time , advances in techniques and technology have allowed ASCs to provide a broader range of services to growing numbers of patients , and we expect those trends to continue . ASCs have the capacity and the ability to provide more patients with access to the top-quality , lower cost care they provide .”
The Vizient / Sg2 forecast projects that inpatient volumes will recover to their pre-COVID-19 levels by 2022 and then plateau . There is also a seismic shift toward changing venues for care .
Hospital outpatient departments ( HOPDs ) and ASCs will continue to experience patient growth ( 19 percent and 25 percent by 2029 , respectively ), with patient volumes projected to increase by 15 million from 2019 to 2029 . The shift in procedures from inpatient to outpatient and from HOPDs to ASCs will help drive down the cost of surgical procedures , the Vizient / Sg2 forecast says .
Outpatient surgery shift will accelerate as CMS eliminates all procedures on the inpatient-only list ( more than 1,700 codes ) and expands the number of ASC-covered procedures by 278 by the end of 2023 .
The paradigm shifts will continue , experts say . Terri Link from AORN observes that a quicker move to outpatient facilities by hospitals and healthcare systems will be likely going forward . “ Already well over 50 percent of procedures are being done on an outpatient basis in hospitals . We ’ ll also see some stockpiling and rotating of supplies to ensure availability and no outdates , as well as firm agreements with suppliers and a plan in place for substitutions and alternate paths to acquire supplies .”
“ One of the lessons we learned over this last year — almost year and a half now — is that during a pandemic or other emergency situation , ASCs can and should continue to provide safe outpatient surgical care to patients in need ,” ASCA ’ s Bill Prentice says . “ Elective surgical procedures are not unnecessary procedures , they are procedures that can be scheduled at a convenient time rather than performed on an emergency basis to save a patient ’ s life . When patients cannot get the elective surgical care they need , their conditions worsen , complications develop and patients ’ quality of life deteriorates , sometimes causing significant hardship for them in their daily lives .”
Prentice adds , “ We have also seen an accelerated shift in patient preferences toward outpatient care . Patients in need of outpatient surgery right now often prefer to have the procedure they need in an ASC rather than inside a hospital that could be providing care to coronavirus patients or patients with other infectious conditions .”
Other key imperatives for the future include overall preparedness , according to Link who explains , “ Better prepared . Awareness of emergency preparedness , inequities in healthcare . Importance of basic infection prevention , masks , hand hygiene , environmental cleaning . May be a move to include IPs as a dedicated position in an ASC not as a staff nurse with other duties as assigned which would include vigilance which takes time . What I mean by this is surveillance to watch for increase in infections , labs that are concerning , making sure that the IP is up to date with surveillance , as well as what to watch for . This includes the center staff to keep them safe . Screening will continue to be important for infectious diseases . Visitors will also need to be monitored and limited . Waiting rooms may look far different . How spaces will be used , and ventilation occurs will also be important . There are many steps that can be taken that do not include increased costs that are basic to infection control and prevention .”
The ASC QC ’ s Kathy Wilson concurs : “ One of the benefits of experiencing this pandemic is a vast amount of progressive learning in the area of disaster preparedness and response ,” she says . “ Although we all hope that we do not experience another pandemic , patients and employees will benefit from policies and plans that came about over the last year . The written disaster preparedness plans that have been revised during the pandemic will serve centers well going into the future .”
References :
Ambulatory Surgery Center Association ( ASCA ). Advancing Surgical Care Podcast : Staying Vigilant Through the Pandemic . Oct . 21 , 2020 .
Taira A . ASCA Survey Confirms Operational Impacts of Pandemic on ASCs . ASC Focus . March 2021
Vizient , Inc . 2021 Impact of Change Forecast : Post-Pandemic Recovery , Rising Acuity and Ambulatory Shifts . June 3 , 2021 .