The connection between lower proce- dure volume and lower revenue could also be expected: 96 percent (373/389) of facilities that reported a decrease in volume of greater than 10 percent also reported lower revenue.

Again, the follow-up Survey 2 con-

firmed the results of Survey 1, with 70 percent (211/301) of respondents reporting overall lower revenue in 2020 compared to 2019. Survey 1 asked about revenue only in the period March 31, 2020, to October 31, 2020, so it is likely that the slightly improved num- ber is the result of Survey 2 contem- plating 2020 as a whole or higher than normal volume after October 31, 2020. Single-specialty ASCs continued to report more severe effects: 80 percent (95/119) of single-specialty Survey 2 respondents reported lower 2020 reve- nue compared to 63 percent (116/182) of multi-specialty respondents.


State-mandated elective surgery stop- pages were not the only reason for reduced procedure volume in 2020. Seventy percent of Survey 2 respon- dents reported higher than usual patient cancellations. The uptick in cancellations was due to a myriad of reasons: the patient themselves expe- riencing COVID symptoms, recent exposure to a COVID-positive person and recent travel prior to procedure date were all considerations that led to a significant number of patient can- cellations in 2020. Patient hesitancy also was an issue: 75 percent (84/112) of Survey 2 respondents whose facil- ities experienced a drop in procedure volume said that patient discomfort with undergoing medical treatment contributed to a significant number of cancellations in 2020.

Operational Impacts

The pandemic drastically altered every- day operations of ASCs and almost all reported making changes to their work-


Tenet Health showed volume reduced by 71.4 percent in March 2020. Likewise, Envision Healthcare reported a 70 percent reduction in ambulatory surgery services during April 2020 alone.”

—Alex Taira, ASCA

flows. Survey 1 respondents reported 100 percent compliance with universal masking and 98.1 percent compliance with social distancing and pre-opera- tive patient screenings per recommen- dations from the CDC.

Both surveys showed most facili-

ties experiencing difficulty maintaining staffing, navigating changing regulatory requirements and acquiring personal protective equipment (PPE). In Survey 1, 87.3 percent of respondents reported “some” to “significant” issues with acquiring PPE, including having to pay more than normal to purchase supplies. Fifty-six percent of respondents to Sur- vey 2 reported issues maintaining facil- ity staff for financial, health or any other reason, with a similar number reporting


Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs. GovtAffairsUpdate

difficulty understanding changing regu- latory requirements.

What Comes Next ASCs likely will continue to feel the effects of the pandemic well into 2021 and beyond. An article from surgeons at Stanford University estimated that a three-month stoppage of elective sur- gery delays could translate to 5 million backlogged

procedures. The delays

also could translate to costlier treat- ments, as postponement likely led to disease progression in many patients, such as those with colorectal cancer. Throughout 2020, ASCA worked with Congress, the White House and other federal officials to support ASCs and ASC physicians. ASCA advocated strongly

for the quick resumption

of elective surgeries in states where capacity allowed, educating lawmak- ers and regulators that “elective” does not mean unnecessary or frivolous. ASCA also

ensured that


pandemic-related financial relief pro- grams, such as the Paycheck Protec- tion Program, Provider Relief Fund and Accelerated and Advance Pay- ments, were made available to ASCs. Via the online ASCA COVID-19 Resource Center, members could find up-to-date information on local, state and federal developments that might impact their facility. Members also accessed a host of new resources such as best practices, FAQs and a hospital outpatient department (HOPD) Medi- care Rate Calculator for those facilities that converted to hospitals via the Hos- pitals Without Walls program. In 2021, ASCA remains committed to serving the interests of the ASC community and continuing to advocate for ASCs as a high-quality, low-cost site of ser- vice for a growing number of outpa- tient procedures.

Alex Taira is ASCA’s regulatory policy and research manager. Write him at ataira@

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