Coronavirus: 3 Steps for Reopening Ambulatory Surgery Centers

Surgical Care Affiliates, which has ambulatory surgery centers in 35 states, has been able to rebound to about 90% of pre-coronavirus patient volume.

This article appears in the July/August 2020 edition of HealthLeaders magazine. 

Safety, managing surgery backlogs, and telemedicine are key elements of reopening ambulatory surgery centers during the coronavirus pandemic, an ASC chief medical officer says.

With the nationwide cancelation of most elective surgeries in March to boost hospital capacity to care for coronavirus disease 2019 (COVID-19) patients, ASCs experienced a dramatic reduction in patient volume. Now, ASCs are reopening with measures to do so safely and efficiently.

"We dropped from 100% volume to about 10% to 15% of volume for an extended period," says Dan Murrey, MD, chief medical officer of Deerfield, Illinois-based Surgical Care Affiliates.

SCA is a division of Optum, which is owned by UnitedHealth Group. SCA has 230 ambulatory surgery centers in 35 states. The facilities are joint ventures with physicians and health systems.

"We are now at about 90% of our pre-COVID volumes. We are feeling very encouraged about the rebound in demand and our ability to safely manage that rebound," he says.

1. Ensuring patient and staff safety

"A lot of focus has had to be put on the safety requirements and the screening practices for patients, staff, and anyone entering the building," Murrey says of reopening SCA facilities.

SCA has enacted eight primary safety measures at its facilities:

• Universal masking
   
• Social distancing
   
• Allowing only one visitor per patient
   
• Uniform coronavirus testing of patients at all SCA facilities in partnership with Secaucus, New Jersey-based Quest Diagnostics
   
• Everyone who enters an SCA facility is asked a series of questions such as whether they have been exposed to anyone known to have COVID-19 and whether they have COVID-19 symptoms. They also undergo temperature testing for fever. Anyone who fails in the screening is turned away and asked to self-quarantine or test for COVID-19.
   
• Limiting the number of staff who enter an SCA facility to essential personnel
   
• SCA, joint venture partners, and SCA's corporate parents have drawn on financial reserves to keep surgical teams on the payroll during the pandemic. "We did not have to rehire people, we did not have to go out and recruit, and the teams know how to work together. Having that consistency improves quality, it improves surgical outcomes, and it improves patient safety," Murrey says.
   
• Securing an adequate supply of personal protective equipment for staff

Testing patients preoperatively for COVID-19 is a critical factor, he says. "In this case, ASCs have a safety advantage over hospitals, which have to take care of patients who have COVID. By not having to treat COVID patients, our facilities are confident that we can create a safe and secure environment, with the screening, the testing, and the personal protective equipment."

2. Managing surgery backlogs

A significant reopening challenge for ASCs has been coping with procedure backlogs.

Efficiency has been prime consideration in addressing surgery backlogs at SCA facilities, Murrey says. "We offered assistance to schedule procedures that had been previously rescheduled by our surgeon partners, and we changed the protocols for how we managed workflow within the facilities to try to optimize efficiency in face of the changes that had to be made due to the safety standards."

Physicians also received clinical guidance to help them address procedure backlogs, he says. "We have created a medical executive board, which is a national policy making body with physicians from across the country. That body met regularly to create guidance on what the most appropriate clinical standards should be and what types of cases should be done first."

Safety was paramount in prioritizing which backlogged procedures were performed first, Murrey says. "From a clinical standpoint, we started with cases that were less likely to spread disease. So, we started with procedures that were non-aerosol-generating surgeries that could be done under regional anesthesia without manipulating the airway or intubating."

3. Boosting telemedicine

Helping physician partners to adopt or expand telemedicine capabilities has been crucial in reopening SCA facilities, he says.

"We have more than 8,000 physician partners who operate in our facilities. Most physician practices were not doing extensive telemedicine prior to the pandemic; but, clearly, telemedicine was going to be the quickest way to not only see their patients in follow-up but also to begin seeing new patients again."

SCA provided physician partners with a telemedicine playbook, Murrey says. 

The telemedicine playbook includes four crucial elements, he says.

• Selecting the right technology
   
• Training staff to manage the technology
   
• Educating patients on how to access telemedicine visits and how to participate in video conferencing
   
• Documenting telemedicine visits appropriately such as making sure that documentation meets all compliance standards and coding to charge for visits