COVID-19 Highlights the Importance of Ambulatory Surgery
Ambulatory Surgery Centers, or ASCs, are independent surgical facilities that provide surgical services to patients who do not require hospitalization for more than 24 hours [2]. From 1990 to 2015, the volume of outpatient procedures has nearly tripled, as ASCs are often more efficient than larger hospitals while performing procedures at lower costs due to lower reimbursement rates from health insurances [3]. With the COVID-19 pandemic pressuring the American healthcare system, there has been an increasing need for ambulatory surgery to complement the role of hospitals.
Near the beginning of the pandemic, most states enacted a ban on elective surgeries from March to May of 2020 [6]. This restriction was set in place in an attempt to reduce infection risk to health providers as well as conserve resources such as N95 respirators, ventilators, and Intensive Care Unit bed space [5][6]. The Ambulatory Surgery Center Association has also recommended that surgical centers should only take in cases where months of delay would cause the patient’s condition to worsen drastically. An aggregate assessment of the risk of delaying a patient’s surgery vs. the risk of proceeding immediately rather than later in a less COVID-19 prevalent environment became a key decision factor. All surgeries, or procedures that do not aim to resolve acute infections, acute traumas, potential malignancies, uncontrollable pain (that would otherwise require hospitalization), or other time-sensitive conditions, were strongly recommended to be delayed indefinitely [4].
However, as the pandemic continues to progress and more and more elective surgeries are being put on the back burner, hospitals fear trying to recovering from the backlog. Already, in orthopedic surgery alone, over one million spinal fusion and joint replacement surgeries have been rescheduled as a result of COVID-19. These growing numbers are delaying resource shortages to a later time, rather than fully lifting the burden from the healthcare system. In addition, deferment of medical care takes huge tolls on the national economy; in the first quarter of 2020, 4.8% of the U.S. GDP decline can be accredited to health care services and delayed elective procedures [6]. Although only elective surgeries are being postponed, many of these surgeries were still prescribed as preventative measures. Indefinitely delaying these treatments will undoubtedly lead to higher costs and worse patient outcomes in the long term [6].
In order to recover from the surgery backlog, the healthcare system can implement several changes. Hospitals and practices should keep improving their telemedicine programs, which can increase efficiency by taking initial surgical consultations virtually, and expanding operating room schedules. In addition, the healthcare system can rely more heavily on ASCs [1]. If ambulatory surgical centers can take on more procedures, then larger hospitals will be able to conserve their resources and healthcare workers for the sickest COVID-19 patients and help fight the progression of the pandemic [1]. Transitioning to more outpatient services and decentralizing care also can expand overall surgical capacity and increase patient throughput in general [6]. ASCs help increase the overall efficiency of the health system and allow hospitals to give more streamlined care to the most pressing demands [6]. In the time of COVID-19 in particular, taking advantage of the option of ambulatory surgery will dissipate some of the pressures on the broader healthcare system.
References
[1] Michigan Medicine – University of Michigan. (2020, September 21). How to improve the surgery backlog during COVID-19. ScienceDaily. www.sciencedaily.com/releases/2020/09/200921130638.htm
[2] Center for Medicare and Medicaid Services. (2020, October 21). Ambulatory Surgery Centers. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Certification and Complianc/ASCs
[3] Hollenbeck, B. K., Dunn, R. L., Suskind, A. M., et al. (2014). Ambulatory surgery centers and outpatient procedure use among Medicare beneficiaries. Medical Care, 52(10), 926–931. https://doi.org/10.1097/MLR.0000000000000213
[4] Ambulatory Surgery Center Association. (2020). COVID-19: Guidance for ASCs on Necessary Surgeries. https://www.ascassociation.org/asca/aboutus/pressroom/press2020/covid-19-guidance-press
[5] Earnhart, S. W. (2020, May 1). COVID-19 Pandemic Closes Many Surgery Centers. https://www.reliasmedia.com/articles/146038-covid-19-pandemic-closes-many-surgery-centers
[6] Jain, A. (2020, August 10). Covid-19 Created an Elective Surgery Backlog. How Can Hospitals Get Back on Track? https://hbr.org/2020/08/covid-19-created-an-elective-surgery-backlog-how-can-hospitals-get-back-on-track