Pandemic Impact Report

In this three-part question and answer (Q&A) series, dozens of surgery center administrators and directors from across the United States were asked about their facilities’ experiences during the COVID-19 pandemic’s early weeks. The leaders talked candidly about their region’s outbreaks, their decisions, and how COVID-19 affected their work and operations:

Gregory P. DeConciliis, PA-C, CASC, administrator, Boston Out-Patient Surgical Suites; Eastern Massachusetts Surgery Center, Waltham, MA

Alfonso del Granado, BHCM, CASC, administrator, Covenant High Plains Surgery Center, Lubbock, TX

Joleen Harrison, RN, BSN, CASC, administrative director, Mankato Surgery Center, Mankato, MN

Terri Mahoney, BN, CNOR, CASC, administrator, Bluffton Okatie Surgery Center, Okatie, SC

Carrie Millsap, chief operating officer, Monterey Peninsula Surgery Center (MPSC), Monterey, CA

Michael J. Patterson, FACHE, president and chief executive officer, Mississippi Valley Health, Davenport, IA

Cindy Young, BSN, RN, CASC, administrative director, Surgery Center of Farmington, Farmington, MO

As the first cases of COVID-19 started emerging across the United States, surgery center leaders had to make tough choices about whether to close, carry on as normal, or modify operations to help treat an expected surge in infected patients.

Same-Day Surgery: How have your surgery center’s operations changed during the crisis?

Young: Our surgery center moved from normal operations to urgent emergent cases for only one week. Then, we stopped performing all elective surgery.

Millsap: After careful consideration and deliberation with local experts and the county health department, MPSC made the determination in March to only perform “time-dependent” cases and [extended] this policy through the end of April. “Time-dependent” cases are identified as either tier 1 (necessary to be performed in seven to 10 days) or tier 2 (necessary to be performed in 30 to 45 days). As a result, MPSC is temporarily closing several locations and consolidating cases to be performed at one facility. This is done in an effort to limit patient risk of exposure, and allows MPSC to treat those patients who need immediate intervention.

del Granado: Our centers suspended what I call “discretionary” elective cases several days before Texas Gov. Greg Abbott issued an executive order that perfectly matched the policy I had put into effect. This has caused a 90% drop in cases. While we could have closed, we are in a joint venture with the local hospital system. We worked closely with them to ensure that we would remain open to take care of necessary cases at our centers so they would not have to be done at the hospital.

At the same time, our national management company, which is also a JV partner, provided us with additional personal protective equipment (PPE) and, more importantly, policies and guidance for exposure risk reduction. They also put in place “quarantine pay” policies to protect the staff if exposed.

Mahoney: Upon the recommendation from the governor, we are only doing urgent cases. Our physicians attest to the necessity of the case. Even prior to this, we went into conservation mode. Beside the significant financial impact, the reduction of cases has [affected] our facility [and] the impact on our staff has been great — the uncertainty of continued employment, financial impact, the stress of the unknown.

DeConciliis: The COVID-19 crisis impacted surgery centers across the nations differently. I’ve heard so many great stories of repurposing ASCs and offering much-needed support during these critical moments.

In our area, we are fortunate to have some of the best hospitals in the country that have exhibited their strength, once again, with handling the COVID-19 surge. Through conversations with [department of public health officials] and some hospital systems, I have tried to assist with medicine procurement, various sorts of PPE, and made requests for staff repurposing. Much of the crisis in our area has centered around the nursing homes, so assistance was needed there the most.

In terms of how we are contributing, we have ensured our staff and patient population is highly screened before entering the facility. We have limited personnel and family members. By creating this “clean” environment, we have marketed ourselves to local primary care providers and surgeons as a viable option to perform their essential surgical procedures in a safe and effective environment. We offered our services to our local hospital as a triage from the emergency room for urgent procedures to allow hospital operating room staff to be available for repurposing and to preserve resources.

Harrison: As a multispecialty ambulatory surgery center [ASC], we are performing essential surgeries only specified by Gov. Tim Walz of Minnesota. We are 50% owned by a multispecialty and orthopedic clinic, so we are helping each other with PPE needs if we can. We are working with the state ASC association to give more information to [Gov. Walz] on options for our surgery centers in Minnesota.

Patterson: We closed our endoscopy facility based on national recommendations. Our multispecialty ASC remained open to provide necessary surgery to those patients in need. We developed a screening process and worked with our physician-led board of directors and our medical director to interpret guidelines and review each case to ensure appropriateness for surgery. We have reduced our volume by over 90%, but remain open to provide surgery two days per week.