One thing I love is the feedback I receive from readers each month. On average, since February, I have received about 120 messages per month. I respond to every one of them. I never divulge the sender information, as I respect your privacy. Here is a sample of the questions I have received in months:

Question: “In light of COVID-19, do you anticipate changes in regulations and/or new policies and procedures for surgery centers and hospitals?”

Answer: There are new regulations and changes to every facility’s policies and procedures already drafted, and many more to come. Check with the Centers for Medicare & Medicaid Services (CMS) and your accreditation organization to make sure you are up to date. Some of these changes are sweeping, and others are anticipated occurring regardless of the virus.

Question: “Is this a good time to build my own surgery center? I do surgery at a center now, but I have been on the fence about doing my own.”

Answer: We receive many calls about this, and each situation is unique. It is anticipated that CMS is going to push more procedures over to ambulatory surgery centers next year.

Also, many hospitals have seen the light and are developing more joint ventures with surgeons on surgery centers rather than their typical hospital outpatient departments’ model for elective cases.

Question: “Now that we have opened up for procedures again, our surgeon owners are pushing the envelope on reducing staffing to make up for losses they had when we were closed. We are state-licensed and Medicare-approved, but they want to use one circulator for two rooms that are operating at the same time. I told them they must have a RN [registered nurse] in each room as a circulator. They argue that the CRNA [certified registered nurse anesthetist] doing anesthesia in the room is a nurse; therefore, they are compliant. Any thoughts on how to deal with this?”

Answer: Due to the gravity of the question, I called this person and explained you cannot have a nurse in the room providing more than one job (i.e., someone providing anesthesia services cannot also be the circulator). As always, go to your state website and check their regulations. Also, you can always call your accreditation organization or CMS directly with any questions.

Question: “When we were forced to shut down our center during COVID, we laid off all our staff, including the RNs. No one knew how long this was going to last, and our docs just couldn’t afford to keep everyone on. We understood that, sort of, but now that we’ve reopened our surgery center, we are having a hard time hiring staff back.

“You would think that everyone would want to get back to work, but we were surprised that much of our pre-virus staff, especially the nurses, had taken other jobs, retired, or were resentful of being laid off. Is it just us, or are other centers experiencing the same thing?”

Answer: Most of us work for a reason. When you lay off employees, for whatever the reason, they still have expenses they need to pay and a job to provide that income. Even now, none of us knows if we are going to be shut down again if the virus resurfaces.

I do know of many surgery center nurses who have taken other jobs in the industry because they need the security of income. It think it is going to become increasingly difficult to find staff for surgery centers in the years to come, certainly in the short term.

Not all surgery centers laid off their staff. Many realized the need to protect and maintain their valuable employees and found reasons to keep them employed during the shutdown, even if that meant running at a loss.

These continue to be daunting times. I encourage everyone to share your experience with other facilities and network as much as possible. Become involved with your state organizations and other groups that cater to surgery centers.

There are many resources out there to provide advice and comfort. Seek them out. Stay safe.

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Address: 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: searnhart@earnhart.com. Web: www.earnhart.com. Instagram: Earnhart.Associates.)