REGULATORY REVIEW


lifting restrictions by early May—the effects on ASCs have been severe.


Effects on ASCs


Numerous sources showed the precip- itous drop in procedure volume as the result of elective surgery stoppages. Tenet Health, which owns ASC man- agement company United Surgical Part- ners International (USPI), showed vol- ume reduced by 71.4 percent in March 2020. Likewise, Envision Healthcare, which owns and operates more than 250 ASCs via the ASC management com- pany Amsurg, reported a 70 percent reduction in ambulatory surgery ser- vices during April 2020 alone. In CMS’ tiered recommendations for prioritizing which surgeries to delay, major ASC- based specialties such as gastroenterol- ogy and ophthalmology were in Tier 1a, the first procedures recommended to be delayed. The results were as expected; a report from FAIR Health, a nonprofit healthcare cost transparency advocate, showed gastroenterology utilization dropped by 73 percent in March 2020 and 77 percent in April 2020 compared to 2019. Orthopedics, another common specialty performed in ASCs, saw over- all utilization drop by 58 percent and 65 percent year-over-year in March and April 2020, respectively.


ASCA, concerned about the pan-


demic’s effects on its member facilities, conducted several surveys through- out 2020 to gather data. The ASCA COVID-19 Financial Impact Survey ran in late April to early May 2020. This survey confirmed severe impacts on ASCs in the period of peak elective surgery stoppages. One third (32/97) of facilities were closed at that time, with two thirds (67/97) having already had to furlough employees. To get a sense of the full impacts of the pandemic, ASCA ran two subse- quent surveys: Survey 1 in mid-Novem- ber 2020 and Survey 2 in March 2021. Although questions differed


slightly, both surveys aimed to help ASCA esti-


Number of Facilities Reporting Procedure Volume Decreases 211


200


■ Decreased by 1–5% ■ Decreased by 6–10% ■ Decreased by more than 10%


150


100


66 50 47 0


Multi-Specialty (n=282)


Single-Specialty: Gastroenterology (n=56)


mate the pandemic’s impact on facility revenue, procedure volume and other operational factors. Survey 1 recorded 631 responses, and Survey 2 recorded 341 responses. ASCs in all 50 states, plus Puerto Rico and Guam, partici- pated in the survey.


Procedure Volume Stoppages on elective surgeries in spring 2020, though brief, caused significant declines in procedure volume: 87 per- cent (537/619) of respondents to Survey 1 reported a decrease in patient encoun- ters relative to 2019 volume, with 63 percent (391/619) reporting a decrease of greater than 10 percent. Large, multi- specialty ASCs reported larger volume drops: 91 percent (150/165) of multi- specialty ASCs with three or more oper- ating rooms (OR) reported a decrease in patient encounters, with 70 percent reporting a decrease greater than 10 per- cent. In California, the state with the most ASCs and the most coronavirus cases, 92 percent (36/39) of respondents reported a decrease in patient encoun- ters, with 77 percent reporting a decrease greater than 10 percent.


Single-Specialty: Ophthalmology (n=91) 13


Single-Specialty: Orthopedics (n=26)


These results were confirmed by Survey 2 in which 82 percent (250/303) of respondents reported “lower” or “significantly lower” pro- cedure volume in 2020 compared to 2019. Interestingly, ASCs are some- what divided on their projections for 2021 procedure volume compared to a normal year of operation: 48 percent (150/311) expect “higher” or “signifi- cantly higher” volume in 2021, while 52 percent expect volume to be normal or lower than normal.


Revenues


The severe reduction in procedure volume had obvious effects on facil- ity finances: 85.5 percent (529/619) of Survey 1 respondents reported over- all lower revenue between March 31 and October 31, 2020, compared to the same period in 2019, with an alarming 59 percent (366/619) reporting “signif- icantly lower” revenue. As expected, small single-specialty ASCs were hit slightly harder: 88 percent of single- specialty ASCs with less than three ORs reported lower revenue, with 61 percent reporting “significantly lower” revenue.


ASC FOCUS JUNE/JULY 2021 | ascfocus.org 21


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