ASC Survival in the Time of COVID-19

With the continued rise of COVID-19 and social distancing, elective healthcare facilities are losing revenue. How can a practice stay financially viable in times like these?

COVID-19 has drastically reduced the number of people seeking care for non-urgent medical issues. Elective surgeries have been particularly impacted, with some ambulatory surgery centers (ASCs) reporting that revenues are down 70%. Your ASC practice is likely worried about how you will continue to operate during the coming months.

Elective Surgeries During the Pandemic

Several states and private healthcare systems have required cancellation or delay of elective surgeries. On March 22, New York Governor Andrew Cuomo introduced an executive order that mandated postponing elective procedures by requiring healthcare providers to establish protocols for evaluating with which cases to move forward. Meanwhile, the Illinois Department of Public Health recommended canceling all elective procedures to decompress the healthcare system. Similar sentiments are echoed all over the United States, with the hope of harnessing PPE, human resources, and ventilators to support COVID patients. 

And even as states allow elective surgeries to resume, many patients still hesitate to seek out medical services, fearing contact with the coronavirus. Such patients are carefully weighing the downsides of delaying elective, non-critical surgery against the risk of infection. As with many other industries that require physical contact, a return to normal hinges on the public’s perceptions of safety—something as unpredictable as the spread of the virus itself.

How ASCs Can Contribute During the Pandemic

Ambulatory surgery centers can play a vital role in the medical system’s response to the COVID-19 pandemic. They can:

• increase the number of beds available to patients (example: an ASC can backstop a hospital by offering an off-site facility for non-COVID hospitalized patients who are stable—like post-cardiac surgery patients—to recover while lowering their risk of contracting COVID)
• provide the necessary equipment and personal protective equipment to other parts of the healthcare system (example: an ASC can divert its PPE, ventilators, and other equipment to local medical centers treating COVID patients and whose frontline medical staff have a dire need for such supplies)
• lend licensed professionals to other facilities to ease the burden on the healthcare system (example: an ASC’s in-house CRNA can provide vital intubation and critical care services at the hospital)

A new model done by Array Analytics found that ASCs could increase the national supply of ICU beds by 21% and also boost the supply of medical-surgical beds by 8%. And even with the addition of ASCs, the number of hospital and ICU beds would not be sufficient for the massive influx of patients during a locale’s peak of infections. This translates to ASCs having great potential to help healthcare systems and other providers better deal with the influx of both COVID-19 patients and non-COVID-19 patients.

Effective transformation and use of ASCs during these challenging times can provide comfort and care to patients who need medical care. While the bulk of the healthcare system is currently dealing with or preparing to deal with COVID-19 cases, ASCs can take steps to provide care for patients who need it, even though the country is in the throws of a pandemic. 

How Can an ASC Pivot?

Your ASC will have to undergo a few changes before it can open its doors to patients outside of the ASC’s normal patient population. The Ambulatory Surgery Center Association released guidance on March 25, detailing some options for  ASCs to help with potential patient overflows in the wake of the COVID-19 pandemic.

One option is to move urgent elective procedures in the community to the ASC. Some of the requirements for making this choice would include coordination with a hospital system to determine urgent elective procedures and facilitating appropriate temporary privileges and credentialing. 

A second option is to transition the ASC to accommodate complex surgical cases, to mitigate patient overflow at hospitals. This would require facilitating temporary privileges and potential assistance from hospitals in the form of necessary equipment, staff, and supplies.

Third, the ASC can expand its services to meet the community’s needs. Examples include creating a triage center to provide the local emergency room with some relief, serving as an infusion center, providing inpatient overnight beds, or providing urgent care for patients without COVID-19. Any of these changes in ASC services would require a scope of service revision and appropriate physician or mid-level staffing. 

Finally, ASCs can provide crucial help through less traditional venues. If an ASC is not currently being used for procedures, it can serve as a sleep or respite center for healthcare providers on the front lines of COVID-19. Additionally, if an ASC is not operational, the ASC staff and any available equipment can go to hospitals and other facilities which are in need.

All of the business pivots that ASCs may make during this time have implications that need to be addressed to ensure continued legal and regulatory compliance. Some of these issues may require eliminating length-of-stay restrictions, allowing transfers from hospitals to ASCs, expanding the list of reimbursed codes, licensing and credentialing, and appropriately allowing an ASC to provide non-surgical services.

The Return to Elective Procedures

First, there’s some good news. An analysis of ASC operations by Jefferies Group analysts noted that the delayed elective procedures and other ASC services would be made up once the immediate impact of COVID-19 tapers. Ambulatory surgical care will continue to be in demand by patients. Patients will always need medical care outside of the medical care that is related to COVID-19. While the interim limitation on elective procedures requires a sacrifice on the part of both ASCs and patients awaiting such procedures, inevitably, patients will need knee replacements, biopsies, fertility treatments, and other procedures provided by ASCs. 

CMS has released guidance on the return to elective procedures for communities with low incidence or relatively low and stable incidence of COVID-19 cases. The new guidelines issued by CMS emphasize a gradual reintroduction of elective procedures in coordination with state and local public health officials. The guidelines also encourage an evaluation of several factors, including levels of personal protective equipment, workforce availability, facility considerations, sanitation, and COVID-19 testing capacity as part of Phase 1 in the Trump Administration’s Guidelines for Opening Up America Again.

CMS also underscores that communities need to pass gating criteria relating to symptoms, cases, and hospitals, before entering Phase 1 of the Trump Administration’s Guidelines for Opening Up America Again. Further, CMS notes that these guidelines are just that—guidelines.  Ultimately, governors and local leaders need to make decisions on whether they are appropriate for their communities.

Best Practices for the Future

COVID-19 is likely going to affect healthcare for some time. While many non-emergent procedures continue to be delayed or canceled, medical societies and other organizations have formed task forces to determine best practices for other time-sensitive procedures. The American Society for Reproductive Medicine’s COVID task force, for example, is working on making recommendations for re-initiation of care for time-sensitive fertility procedures and will release their best practices in the weeks to come.

For guidance navigating these complex and quickly changing issues, consult the experienced healthcare attorneys at Jackson LLP. 

The COVID-19 pandemic is a dynamic and evolving public health emergency. The laws and situation are fluid, and this article may not reflect the most current situation.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.