ASCs Severely Impacted by COVID-19 Pandemic ASCA continues to support surgery centers through persistent advocacy BY ALEX TAIRA

On January 31, 2020, then Secretary of the US Depart- ment of Health & Human Services (HHS) Alex Azar formally declared a public

health emergency (PHE) in the US due to confirmed cases of the 2019 novel coro- navirus (2019-n-CoV, which became known as COVID-19). At that time, we did not yet know how this new disease would impact our healthcare system or daily life. In the press release announc- ing the PHE declaration, Secretary Azar noted that “the risk to the American pub- lic remains low at this time.” On February 25, 2020, Nancy Mes-

sonnier, MD, director of the National Center for Immunization and Respi- ratory Diseases (NCIRD) at the Cen- ters for Disease Control & Preven- tion (CDC), held a press conference. During her remarks, she warned of pending severe “disruption to every- day life” and gave the first outline of safety measures that would become all too familiar in the coming months. The measures included protective actions such as voluntary home quar- antine, teleschooling and telework- ing, postponement of mass gather- ings, and delays to elective surgeries. Just one day after the press confer- ence, on February 26, 2020, the CDC confirmed the first community infec- tion case of COVID-19 in California in a person who did not have a rel- evant travel history or exposure to a known COVID-19 patient. By March 10, the US confirmed

1,000 cases. On March 11, the World Health Organization (WHO) issued an official declaration of a global pan- demic. An Oval Office address from then President Donald Trump and the indefinite suspension of the National Basketball Association’s (NBA) sea- son and many other events quickly

followed. The next week, ASCA cre- ated an online reference, the ASCA COVID-19 Resource Center, to help its members keep track of news, regu- lations and recommendations amidst an environment of increasing change and uncertainty.

Elective Surgery Stoppages Elective surgeries were a major focus for ASCA during the first weeks and months of the pandemic. Because elec- tive surgeries are, by nature, non-emer- gency medical procedures, many state and local authorities were quick to rec- ommend that any nonessential elec- tive procedures be postponed so that all available care capacity and personal protective equipment (PPE) could be redirected toward COVID-19 patients. A March 15, 2020, memorandum

from the Massachusetts Department of Public Health (DPH) to ASCs in the state directed facilities to “postpone or cancel any nonessential, elective inva- sive procedures.” Many states followed with similar orders and ASCA tracked at least 35 states that restricted elective


surgeries to some degree, mostly in the first few months of the pandemic. Also on March 15, new guidance

from the Centers for Medicare & Med- icaid Services (CMS) outlined a tiered decision-making approach to limiting non-essential adult elective surgeries. ASCA quickly recognized the dangers in imposing blanket restrictions on elec- tive surgeries and released recommen- dations on March 16, 2020, designed to show ASCs as vital components of the COVID-19 care continuum while also helping to preserve patient access to surgeries where appropriate. Despite similar statements from major health- care associations cautioning against blanket curtailments of procedures, multiple members of the White House Coronavirus Task Force, including Vice President Mike Pence and CMS Administrator Seema Verma, contin- ued to make strong statements advocat- ing for delays in elective procedures. Although stoppages would not last long—CMS released Phase I recom- mendations for resuming elective sur- gery on April 19, 2020, with most states

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