ASCs and COVID-19: How to Handle Surgical Overflow

With the COVID-19 pandemic evolving daily, the Ambulatory Surgery Center Association (ASCA) has released a list of scenarios in which ASCs can be activated to handle surgical overflow. We’ve summarized the ASCA’s list of options for how ASCs can assist with surge capacity.


1. Take on outpatient urgent elective procedures

Right now, patients are being urged to reschedule elective procedures. However, some surgeries, while elective, are still pressing. ASC leaders could coordinate with their hospital system to accept cases of urgent elective operations. In some instances, ASCs could take on emergency fracture surgeries, excluding hip fractures. ASCs may need to consider expanded hours of operation, such as adding weekend hours, and would need temporary privileges for these procedures.


2. Accommodate complex surgical cases

Ambulatory surgery centers could help with hospital overflow by accommodating more complex surgical cases. This would include inpatient and outpatient cases and would require an expanded list of reimbursement codes and the temporary elimination of length of stay restrictions. While the hospital could assist by providing necessary equipment and supplies, the list of surgical options would need to fit within the center’s specialty offerings and capabilities.


3. Expand to meet varying community needs

Surgery centers could expand in varying ways to meet other hospital needs. ASCs could serve as triage centers to assist with emergency room overflow, serve as infusion centers, birthing suites, provide inpatient overnight beds, or offer urgent care services for non-COVID-19 patients. All of these options would require regulatory engagement to evaluate licensing, payment methodology, etc. However, pivoting in these specific ways could significantly help with hospital surge capacity.


4. Further expand to assist with the COVID-19 outbreak

ASCA notes that if surgery centers evolve to help with COVID-19-specific services, it would be difficult to backtrack and opt for options 1-3.

However, if licensing, payment methodology, and ability to provide non-surgical services in an ASC setting were engaged, ASCs could provide extra support for providing COVID-19 care. With an on-side MD or mid-level provider, ASCs could provide COVID-19 testing and act as a triage center. Providers would need to quickly determine a quarantine and isolation strategy for those who are high-risk and need access to test kits. If an ASC had access to the appropriate equipment, surgery centers might also pivot to serve as an ICU setting. In these cases, there would need to be regulatory engagement to eliminate the time limit on lengths of stay.

5. Offer facility or resources if not providing medical services

If an ASC is not offering medical services, the physical facility or resources can still be utilized. For example, surgery centers may be used as sleep centers for hospital call teams. They may also offer the assistance of their staff of use of their resources. This option may be a strategic option if the ASC cannot provide any of the services mentioned above.

If none of these are feasible, consider other things you can do while your ASC is shut down or slowed down. Comment your thoughts down below, and feel free to leave a suggestion for future blog topics!