A Progress Report on Resuming Elective Surgery

On April 22, 2020, Bill Prentice, ASCA chief executive officer, and Michael Patterson, president and chief executive officer of Mississippi Valley Health in Davenport, Iowa, recorded an episode of ASCA’s Advancing Surgical Care Podcast that looked prospectively at the resumption of elective surgeries. In this episode, recorded two months later, Bill and Michael rejoin their discussion about elective surgeries and provide a detailed update on the progress, as well as the continuing challenges, occurring in outpatient surgery.

Transcript

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Bill Prentice:   0:06
Hello and welcome to the Advancing Surgical Care Podcast brought to you by the Ambulatory Surgery Center Association. My name is Bill Prentice and I'm ASCA’s CEO and host of this episode.

This recording is taking place on Monday, June 15, 2020, and on this episode of our podcast, I'm very pleased to welcome back Michael Patterson, president and CEO of Mississippi Valley Health in Davenport, Iowa. On April 21, just two months ago, Michael and I recorded a podcast that prospectively looked at resuming elective surgery. We had a rather detailed discussion about the steps that ambulatory surgeries would have to take to safely reopen while the COVID-19 virus was still with us. I've invited Michael back today to talk about his experience with the COVID-19 protocols he's established and how both staff and patients are responding to them. I also want to take this opportunity to congratulate Michael—he's not only the president of Mississippi Valley Health, he was also recently elected by his colleagues on the ASCA Board as our new president for the next two years. Michael has been on the ASCA Board since 2014 and most recently served as chair of ASCA’s Government Affairs Committee. Michael, welcome back to the Advancing Surgical Care Podcast.

Michael Patterson:   1:19
Thanks, Bill, happy to be here and looking forward to a discussion around how do we move forward.

Bill Prentice:   1:24
Great. Well, as I mentioned at the outset, it's been about two months since you and I recorded our first podcast on the subject of resuming elective surgery. Most of our conversation then was focused on the things you needed to be ready to do to safely welcome patients back to your surgery centers. Let's have a quick update on the progress that you've made there.

Michael Patterson:   1:43
Sure, Bill. In regard to progress, both facilities are now open Monday through Friday, and we have resumed providing surgical care to patients. We have a well-developed supply chain for PPE. Our medical executive committee and our board have worked very hard in developing and improving appropriate policy and processes for enhancing the safety and efficacy of our infection prevention program. And in addition, our staff have been educated on all these new updates.

Bill Prentice:   2:12
That's great. And let's start where you just ended. Tell me about how your staff have responded to the resumption of surgeries and these new protocols.

Michael Patterson:   2:20
It's been an interesting time. The staff are passionate about providing care for the surgical patient population. But at the same time, they're also cautionary in regard to not only their own health and safety, but for those family members that live at home with them as well as the patients and their family members that we're going to be caring for here in a couple of our facilities. The staff have done well to be educated. We've tried to take their knowledge base of COVID and really enhance what we're doing from a safety process perspective and engage them in that dialogue around what do they feel they need in order to provide safe and effective healthcare in our ambulatory surgery centers.

Bill Prentice:   3:02
Well, that's great. And I think that's going to be really important going forward because, you know, obviously our staff are on the front lines, they're the ones seeing those patients and family members throughout the day, and making sure that they're staying safe has to be a priority. But let's talk now about the patients. How have they responded to resuming surgery?

Michael Patterson:   3:21
It's interesting. I think some of the challenges that continue are getting patients comfortable with seeking treatment, ensuring we have COVID testing results back in the appropriate timeframe, ensuring patients understand what self-quarantining means. And I think that when we've talked with patients, some of them are actually just hesitant to come into the physician's office. And in order to see patients in the surgery center, they actually have to, you know, see patients in their physician clinic, have a dialogue with a surgeon, and some of those now are occurring via telehealth. And I think that poses some opportunities and some challenges both in regard to how do we appropriately assess a patient and prepare them for surgery based on either a telehealth visit or an in-person visit.

Bill Prentice:   4:08
That's really interesting. And in terms of having to explain about self-quarantining, to what extent have you been using testing as part of your protocol?

Michael Patterson:   4:18
Patients have been happy to hear that we're resuming surgery in both our surgery center and our GI facility, and several of them have asked how are we keeping them safe while in our facilities. We are screening all of our surgery patients 48 hours prior to surgery, and then asking them to self-quarantine until their surgery day. We have continued to limit visitors. All of our staff are wearing masks in the ASC. And we continue to screen all employees, patients and providers prior to entry into the facility on a daily basis.

Bill Prentice:   4:48
It's tremendous, and I'm sure that that's a great comfort to your patients and prospective patients. And so, since we obviously had to all but shut down when the pandemic first started and was really, obviously, a big national issue, how has the volume of procedures you're performing changed? How do they compare, for example, to pre-closure levels?

Michael Patterson:   5:10
Volumes are coming back in waves. There are certain specialties that had more demand sooner, and we've been lucky to be able to accommodate them in a timely manner. We are at about 50 percent of our pre-pandemic volume in the surgery center. And we are at about 25 percent of the volume in our endoscopy center. We have started to perform screening and surveillance procedures for our endoscopy center patients as of this week. Our endo facility was actually closed for about a month. Our surgery center facility, it stayed open for surgeries two days a week. And I think we are going to continue to see a return of volume through the end of the year as patients get more comfortable seeking treatment. And now that we can do things such as cataracts, colonoscopies, both screening and diagnostic, pain procedures and a few others, I think that we will slowly start to see that volume ramp up through the end of the year.

Bill Prentice:   6:08
You know, you mentioned that you were still seeing some patients during the depths of the pandemic, you know, in March and April, and we know that many ASCs still performed a limited amount of necessary surgery during those months, March and April. And indeed, the ASC Quality Collaboration is now surveying ASCs to find out how they fared in terms of providing that care without spreading coronavirus. And the early results I've seen from that survey are very promising. What was your experience over that timeframe while you were still seeing, you know, a handful of patients?

Michael Patterson:   6:42
So, we treated everybody as suspected. We had full PPE throughout their entire process here and both facilities and ensured their safety. We followed up with those patients and, for those that went to get testing either on their own or for other reasons, we wanted to track them and see how that progressed. Now that we're testing every patient, we've only had about a handful of patients that have come back positive that actually were asymptomatic and didn't even know that they were positive. And so, we put a protocol together for how to handle those patients as well, which includes a follow-up with their primary care physician and a return to the surgical suite after so many days of being asymptomatic. And I think that, you know, with those types of patients, the physicians as well as the staff are being cautious to make sure that we're not doing surgery on patients that have an active COVID infection going on currently.

Bill Prentice:   7:37
You know, as I think about one of the major reasons why surgery centers and so many other healthcare facilities needed to close or suspend operations or dramatically shorten the time they were open had to do with personal protective equipment, and shortages that were either, you know, in existence in certain markets or there was an expectation that there would be shortages, you know, if the pandemic continued to spread and overwhelm the healthcare system. What are you finding today with regard to getting that PPE and having what you need to be able to operate safely?

Michael Patterson:   8:12
So, we've been fortunate to acquire the appropriate amount of PPE for both of our facilities, through either our own supply chain or early on through our local county health management department.

Bill Prentice:   8:24
I'm sorry, I just want to jump in. Has the pricing of it changed?

Michael Patterson:   8:27
Of course the pricing has changed. Here in our particular state, there were a keen eye to price gouging, and I think we've mitigated most of that by just not engaging with those vendors that wanted to price gouge. Now obviously, there is a supply and demand and we needed to provide care for patients. And as such, we paid the appropriate price, I think, in regard to that PPE because had we not had it, we wouldn't have been able to service our customers.

Bill Prentice:   8:56
Exactly. Finally, even with some reopening of the economy, we're already starting to see troubling signs of more COVID-19 cases in different areas of the country. And in addition, you know, many public health experts are still warning of a second wave. So, recognizing we're still in the initial pandemic, there's an expectation that there could be a spike in cases in the fall and winter. What should ASCs be doing today in anticipation of that happening?

Michael Patterson:   9:25
Bill, it's something that should be on every ASC CEO’s mind. Preparing for what comes next will be important. The anticipated second wave should be of no surprise to anyone. If we continue to utilize appropriate protocols, ensure supply chain consistency and work with our physician partners to understand what is happening in their clinics, we should be able to ensure streamlined operations for our ASCs. The first step will be to understand what our physicians are experiencing in their clinics and how we can partner with them to ensure appropriate scheduling and preop screening of their patients. In addition, we need to educate patients and families regarding the PPE measures that ASCs have taken to ensure the safety and health of the patients that are seeking treatment in our facilities. If an ASC is not screening and/or testing, they should be working on getting those processes in place now so that way when the second wave comes, they are prepared for these events.

Bill Prentice:   10:21
Well stated. And one of the things that ASCA is viewing as an advocacy priority right now is developing the case and the argument that we can safely see patients through the rest of this pandemic. That even if there is a spike in a community, so long as we're doing all the things that you outlined in terms of protecting the patients and the staff and screening, we should be able to safely continue to see patients and we should not have to shut down and suspend operations, like we did in March and April. So that's going to obviously be a priority for the association and something that we'll be looking to develop, you know, all the data and tools to ensure that policymakers understand that we can safely continue to see patients.

Michael Patterson:   11:10
Yeah, I believe the resources that ASCA is developing and providing for their members will be important. There's a lot of resources out there. But I think when we think about the ambulatory surgery center industry, ASCA being the leading association for that industry, we should, you know, really look to the thought leaders. And hopefully, we will ensure that we continue to update policies and procedures as more information comes out and be the resource for our ASC members.

Bill Prentice:   11:40
Well, that's right and that's a great segue into me reminding our listeners that we have a COVID-19 resource page on our website that continues to be added to and supplemented, and is a great first place for people to go to find out about how to do the things that Michael has mentioned and all the regulatory things that we're working on to ensure that ASCs can continue to see patients during the pandemic. So, Michael, thanks again for being on this podcast and for, you know, being part of this discussion.

Michael Patterson:   12:11
Thank you for the invite. I appreciate the opportunity and look forward to the ASC industry being part of the solution to healthcare in our country.

Bill Prentice:   12:21
Great. For our listeners’ sake, I want to thank Michael Patterson for coming on to the Advancing Surgical Care Podcast and sharing his knowledge and experiences with us. If anyone listening has thoughts or suggestions for future topics or how we might improve these presentations, please share them. We want to hear from you so that we can serve you better. Thanks for listening and please stay safe and healthy.