REGULATORY REVIEW
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
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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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