COVID-19 RESOURCE & UPDATES


Update 04/07/2020

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Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency 

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.

Application 

Guidance


Update 04/06/2020

Ambulatory Surgery Center Association (ASCA)

New Checklist Helps ASCs Provide Expanded Services During COVID-19 Response

ASCA has released a checklist ASCs can use to identify the key elements they need to consider as they prepare to provide expanded services under the temporary rules and waivers the Centers for Medicare & Medicaid Services announced in response to the COVID-19 national emergency declaration. The checklist is available in a downloadable Excel file that ASCs can complete digitally and use to record notes and information on the individual items on the list.

Download Checklist

The checklist is part of a comprehensive set of online resources now available from ASCA to assist ASCs in their COVID-19 response. Those resources are still being updated daily.



 

Update 04/03/2020

Small Business Administration

 

Coronavirus Relief Options

Funding Options

In addition to traditional SBA funding programs, the CARES Act established several new temporary programs to address the COVID-19 outbreak.

Image of shield with money in it.

Paycheck Protection Program


This loan program provides loan forgiveness for retaining employees by temporarily expanding the traditional SBA 7(a) loan program.

Learn more
Circle with document in it and text that says 10,000 dollars.

EIDL Loan Advance


This loan advance will provide up to $10,000 of economic relief to businesses that are currently experiencing temporary difficulties.

Learn more
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SBA Express Bridge Loans


Enables small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 quickly.

Learn more
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SBA Debt Relief


The SBA is providing a financial reprieve to small businesses during the COVID-19 pandemic.

Learn more

 

 Update 04/03/2020

ASCA Takes a Closer Look at CMS’ Waivers and Federal Assistance Related to COVID-19

 

A new Q & A is now available online from ASCA that looks at:

 

  • what the temporary regulatory waivers and new rules announced by the Centers for Medicare & Medicaid Services on March 30, 2020, mean for national COVID-19 response efforts and ASCs 
  • how ASCs can access federal loan assistance now available to enable you to continue to provide safe, high-quality care to patients during and after the COVID-19 pandemic

 

This resource and many others that can help support ASCs during the COVID-19 pandemic are available in a special COVID-19 Resource Center that ASCA updates as new information and resources become available. 


 

 

Update 03/30/2020

Additional Background:Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

INCREASE HOSPITAL CAPACITY -  CMS HOSPITALS WITHOUT WALLS

CMS is allowing healthcare systems and hospitals to provide services in locations beyond their existing walls to help address the urgent need to expand care capacity and to develop sites dedicated to COVID-19 treatment. 

Under federal requirements, hospitals must provide services within their own buildings, raising concerns about capacity for treating COVID-19 patients, especially those requiring ventilator and intensive care. Under CMS’s temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. For example, a healthcare system can use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients. 

Ambulatory surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries, and other essential surgeries.  

Read the full sheet here


 Update 03/30/2020

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system, and is the nation’s largest health insurer serving more than 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and Federal Exchanges.

Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. This allows hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility.

Read the full changes here


Update 03/29/2020

Texas Medical Board Updates FAQs for Elective Surgeries during COVID-19

COVID-19 Elective Surgeries and Procedures FAQs (Updated 3/29/20)


Update 03/27/2020

2.1 Directions for IMMEDIATE Reporting of NEW Required Information to DSHS

In accordance with the emergency reporting requirements, ASCs must report the number of functioning ventilators and other respiratory support equipment they have, and any other information as required by DSHS. Due to the urgent need of this information for emergency response to COVID-19, the first required report is due NOT LATER THAN 10:00 am CST, on Monday March 30, 2020.

To report this critical information by the required timeframe, ASCs shall use the reporting form at this link:
https://app.smartsheet.com/b/form/d8a40549d4f64694b9022854a 09d4884

ASCs must report this information by the required due date but are strongly encouraged to report this information as soon as possible. The frequency for reporting required information is weekly, unless directed otherwise by DSHS.


 

Update 03/27/2020

Read the full rules here


 

Update 03/25/2020

Read the full rules here: 

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/memos/gl-20-1003.pdf


 

Update 03/24/2020 

New Tool from ASCA Can Help Your ASC Support Community-Wide COVID-19 Response

As communities across the country work to coordinate their response to the growing numbers of COVID-19 cases being identified, ASCs may be asked to contribute in critical ways. To help, ASCA has developed a simple form ASCs can download and use to record and share information about the resources and capacity they can contribute.

ASCA encourages all ASCs to download and complete the checklist today so you can provide this essential information immediately if federal, state or local officials, or even local hospitals in your market, request it.


 

Update - 03/22/2020 

TASCS Members, 

We are requesting that you reach out TODAY and ask your Senator to support inclusion of the Barrasso-Bennet Immediate Relief for Rural Facilities and Providers Act in the COVID relief package. It will ensure that ambulatory surgery centers and other outpatient facilities can maintain operation and be at the ready to serve patients both during this period of crisis and once it subsides.  

Many of our centers are already laying off staff and don’t see any light at end of the tunnel and could close. Barrasso-Bennet would help by providing grants and low interest loans to physician practices and ambulatory surgery centers so they can stay afloat. It is urgent that you contact your Senators today, as soon as possible. The Senate is working to finalize the next Coronavirus relief package and your input is needed.  

If you know of others in your state that have a relationship with a Senator please forward this email on and ask them to contact that office. 

 

Please send this letter to you US SENATORS ONLY:

 

Senator Cruz via Joel Heimbach [email protected]

 

Senator Cornyn via Jeffrey Last [email protected]

 

A letter template is attached here for you to use.


Update - 03/20/2020

 

COVID-19: A Message to ASCs

 

Last Updated: March 20, 2020

 

Dear Colleague:

As the nation continues to take unprecedented action to manage the COVID-19 pandemic, we want to provide some critically important reminders to the ASC community.

First, strictly adhere to federal and state guidance to immediately postpone all surgeries that can be delayed for 6 to 8 weeks. This is a critical step in slowing the transmission of the virus.

Second, as you are well aware, the healthcare system is facing a critical shortage of certain medical supplies and personal protective equipment. Use these resources sparely and wisely.

Finally, the increasing stresses of the pandemic on traditional hospital services may soon lead to federal and state government decisions to use ambulatory surgery centers to support the healthcare system in expanded surgical use and new ways during the pandemic. You must be prepared for your ASCs to work in coordination with local hospitals to manage care and patients not currently contemplated, most of which will require regulatory waivers and other guidance that could be forthcoming in the very near future. We encourage all ASCs that have not already done so to communicate with your local hospitals to ensure a coordinated response in the best interest of your communities.

We recognize that all of this is unprecedented but be assured that ASCA will continue to be a trusted advocate and resource for you as we all work together to meet these challenges.  

Bill Prentice
Chief Executive Officer
Ambulatory Surgery Center Association

Larry Taylor, CASC
President
Ambulatory Surgery Center Association 

P.S. For those ASCs that are continuing to offer emergent surgical care, we are providing some expanded safety guidelines designed to help you keep your patients and staff safe.


 

 

Update -03/20/2020

Accrediting Organization Updates:

AAAHC SURVEYS PRIORITIZED OR POSTPONED WITH A FOCUS ON PATIENT SAFETY AND PATIENT ACCESS TO QUALITY CARE
Full Statement Here

The Joint Commission is suspending all regular surveying
Read the full statement


 

Update - 03/19/2020 

Alert: Important coronavirus updates for ophthalmologists

March 18, 2020 – The American Academy of Ophthalmology has released new recommendations regarding urgent and nonurgent patient care. According to the statement, all ophthalmologists should cease providing any treatment other than urgent or emergent care immediately. This includes both office-based care and surgical care.


Read the full alert here


Update - 03/18/2020

ASCA Releases : COVID-19: Guidance for ASCs on Necessary Surgeries

In response to government guidance that hospitals and ambulatory surgery centers postpone elective surgeries during the COVID-19 pandemic, the Ambulatory Surgery Center Association (ASCA) has consulted with clinical leaders to solicit recommendations on how and when facilities should proceed with cases that, for clinical reasons, should not be postponed. A surgery may be deemed urgent and necessary if the treating physician decides that a months-long delay would increase the likelihood of significantly worse morbidity or prognosis for the patient.

Read the full release here


Update - 03/16/2020

TASCS participated on the ASCA COVID-19 call this afternoon and is recommending that members closely monitor and follow the CDC guidelines at this time.  Recommendations are changing rapidly and TASCS is working with the state and other specialty societies to monitor changes and will send alerts to members as soon as information is available.  Below are resources for our members:

ASCA Statement on Elective Surgery and COVID-19:
https://www.ascassociation.org/asca/resourcecenter/latestnewsresourcecenter/covid-19/covid-19-statement

ASCA COVID-19 Resources: 
https://www.ascassociation.org/asca/resourcecenter/latestnewsresourcecenter/covid-19



You can review CDC guidelines here:

Considerations for specific settings:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html

Outpatient facilities

  • Reschedule non-urgent outpatient visits as necessary.
  • Consider reaching out to patients who may be a higher risk of COVID-19-related complications (e.g., elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women) to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
  • Consider accelerating the timing of high priority screening and intervention needs for the short-term, in anticipation of the possible need to manage an influx of COVID-19 patients in the weeks to come.
  • Symptomatic patients who need to be seen in a clinical setting should be asked to call before they leave home, so staff are ready to receive them using appropriate infection control practices and personal protective equipment.
  • Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.

 


 

In the meantime, below are a list of best practices some Texas centers are currently implementing:

Patient Sign In & Patient (and employee) Screening
-Signage is posted at the front door staring if they have traveled outside the US in the last 14 days, or have fever, cough or SOB- do not enter and call the number below
- Center signs in the patient and they sit briefly in the wait area until called back
- Patient asked to use their own pen, otherwise provide a “stick pen”
- Everyone who enters the ASC will be screened at the door and given a mask for screening questions (Questions are asked about travel – both domestic and abroad AND temperature  is checked ). This includes physicians, staff, patients, delivery, etc.  If they test positive, they are referred to their PCP or ER.  If they are a patient, the case is cancelled.
- Block off one private PACU room to be the isolation room in the event someone with symptoms presents to the facility
- Created a response team that knows how to wear N-95 masks and other PPE and can isolate the patient and assess

Waiting Rooms/Lobby Areas
- Pull all magazines and newspaper from wait area
- Limit family to one person over 18 in clinic area IF any at all
- Visitors will not be allowed in the center -patients will be dropped off and picked up curbside. Patients are called the day ahead of time and screened and told of procedures for drop off and pick up.
- Driver is offered to wait in vehicle (we have a card for cell, name, car type)
- The waiting area is cleaned every hour and reception cleaned after each patient
- All personnel are wearing PPE and using properly

Cancellation/ Reschedule
- Rescheduling nursing home patients
- All elective cases are cancelled until further notice
- No visits/procedures/surgeries for anyone over 60 (all rescheduled until Apr 1)
- Postpone all elective, non-critical cases until March 31st. This includes procedures such as screening colonoscopies, non-urgent surveillance colonoscopies, cataract procedures, cosmetic surgeries and other elective type cases that can appropriately be postponed.
- Eliminate the use of fellows/residents in the ASC, as well as limiting necessary people scrubbed in to cases to conserve gowns/masks

General Sanitation
- Perform “sanitization rounds” every two hours
- Wipe chair arms, door handles, bathroom door latches, faucets, and toilet handles and seats.

Supply Chain & Other State Resources
On March 13th Governor Abbott Declares State of Disaster In Texas Due To COVID-19, read the full proclamation here: 

https://gov.texas.gov/news/post/governor-abbott-declares-state-of-disaster-in-texas-due-to-covid-19

By declaring a State of Disaster, a number of actions are triggered by the Governor, including:

  • Providing the immediate ability to move resources around the state, including resources obtained through the Strategic National Stockpile.

Find out more details about the Strategic National Stockpile here:
https://www.phe.gov/about/sns/Pages/default.aspx

You can find more resources from screening tools, infection control updates and requests for assistance here:
https://dshs.texas.gov/coronavirus/healthprof.aspx

Insurance
- Call your insurance provider for details regarding any “business interruption” insurance you may have

Small Business Administration
- Use the resources on the SBA site to see what resources are available to you:
https://www.sba.gov/page/guidance-businesses-employers-plan-respond-coronavirus-disease-2019-covid-19