Outpatient surgery conundrum amid COVID-19 outbreak

Should ambulatory surgery centers (ASCs), hospitals and office-based surgical settings continue to perform elective surgeries during the novel coronavirus (COVID-19) outbreak? Nearly across the board, the consensus is "no."

On March 14, U.S. Surgeon General Jerome Adams asked hospitals and healthcare systems to consider stopping elective procedures. Four days later, the Centers for Medicare & Medicaid Services (CMS) recommended all non-essential, elective surgeries be delayed. The Ambulatory Surgery Center Association (ASCA) stated that "… if a procedure can be safely postponed without additional significant risk to the patient, it should be delayed until after the pandemic." Numerous other associations, including the American Society of Anesthesiologists and American Medical Association, have announced similar positions. And many states have issued guidance on elective surgeries.

There are good reasons why governments and organizations are making such recommendations. Temporarily halting elective surgeries reduces potential transmission of the coronavirus among patients, their family members, medical staff and vendor representatives who travel to facilities to undergo, perform and support procedures.

In addition, some personal protective equipment, other supplies and medications used by surgery providers are needed for those who are seriously ill from or at high risk of becoming infected by the coronavirus.

And then there's simply doing the right thing. When healthcare providers take the coronavirus threat seriously, they are sending a message of personal responsibility to the communities they serve.

Surgery providers around the country have heeded the advice and closed or significantly reduced their operations.

But not all.

Another Perspective
As we're hearing on the news — and reading in reports, such as this Washington Post article — for some elective surgery providers, it's essentially business as usual, with a few extra infection-prevention measures in place.

How are these providers justifying their decision? A few ways. As the Post article states, "But for some operations, shutting down elective surgeries is shutting down their whole business and potentially the livelihoods of their staff." Such is a concern for businesses around the country.

Some providers have argued that this is a good time for consumers to undergo surgery. With many businesses closing or reducing their operations, people have free time on their hands. Why not get a surgery out of the way and be recovered or well on the way toward recovery when life returns to normal? And for those fearful of losing their jobs, this could be their last chance to undergo procedures before losing their employer-sponsored insurance.

Another argument made by surgery providers remaining open is that elective surgery not only meets consumer demand but can also significantly improve quality of life if the procedure reduces or eliminates pain, improves mobility or contributes to well-being in another way.

Some ASCs on ASCA's discussion board say they are remaining open with skeleton crews to take cases from hospitals that can be safely performed in the ASC setting, thus freeing up much-needed hospital resources.

Avanza's Perspective and Recommendations
While I understand the arguments for continuing to provide non-essential, elective surgeries, I do not believe the ends justify the means. In the interest of safety and efforts to flatten the curve, Avanza Healthcare Strategies recommends providers stop performing elective surgeries immediately. We recommend facilities assess their inventories and identify supplies and medications they can distribute to hospitals and other organizations during this time of great need. We also suggest outpatient surgery providers communicate with their local hospitals and other organizations delivering essential healthcare services to identify other ways they can provide much needed support.

In anticipation of eventually reopening, surgery providers could also take advantage of this down time and assess their operations. Conduct a deep dive into operational and clinical metrics and identify ways to improve performance. Review policies and procedures to prepare for your next accreditation survey. Keep staff engaged by tasking them with examining supply storage and checking for expired items. Work your accounts receivable to keep revenue flowing. Use this time to clean up unpaid insurance claims, assess the contents of procedure packs and ask your physicians to update their preference cards.

While no business wants to close its doors, surgery providers can take solace in the fact that there likely will be a surge in demand for elective surgeries once the coronavirus is behind us. We witnessed this when assisting ASCs following hurricanes Harvey and Katrina and expect the same now. While it may take time to offset financial losses, most well-run surgery providers will recover. This cannot be said for businesses in other sectors that may not survive the pandemic itself or the economic crisis that follows.

Avanza strongly recommends ASC owners and administrators use this time to do what they can to make their ASCs even more successful when this crisis is behind us. The future of elective, outpatient surgery is bright as ever. To ensure this remains true, surgery providers should prioritize public safety above all else.

Joan Dentler (jdentler@avanzastrategies.com) is president and CEO of Avanza Healthcare Strategies, which provides healthcare organizations with strategic guidance, with a focus on outpatient services. For more than 25 years Ms. Dentler has been consulting on, developing or operating ambulatory surgery centers, hospital outpatient services and community health initiatives.

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