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In the face of unprecedented national emergencies, such as hurricanes or pandemics, ambulatory surgery centers (ASCs) have increasingly demonstrated their potential to serve as vital lifelines. 

The COVID-19 pandemic revealed just how crucial ASCs could be, stepping in to relieve overburdened hospitals and providing a safe space for essential procedures. With both natural disasters and health crises becoming more frequent, ASC operators and policymakers are re-evaluating how these centers can best support public health efforts in times of need.

The pandemic marked a watershed moment for ASCs as more complex procedures, typically reserved for hospital settings, were temporarily approved for outpatient facilities to alleviate overcrowded hospitals, Jeffrey Flynn, president of the Gramercy Group and the New York State Association for Ambulatory Surgery Centers, told ASC News. 

While ambulatory surgery centers were initially overlooked during the pandemic, Flynn said that the emergency necessitated more conversations about the role of ASCs in the health care continuum.

Initially, ASCs weren’t designated as facilities for essential surgeries, which led to delays in elective procedures and critical screenings, contributing to documented spikes in advanced-stage cancers, Flynn said. 

“But what we noticed during the pandemic is that we were open to do essential elective cases,” he said. “So for what we deemed an essential case, we had to determine that these were cases we could handle. During that period, when they shut us down for elective cases, which turned out to be about eight weeks, they forgot to classify us as a place where essential cases could be done. So, we had to apply to be recognized as an essential service.” 

This lack of understanding from political leaders on the role of ASCs led to industry leaders advocating for their inclusion, allowing centers to perform necessary procedures that prevented more serious health issues, Flynn said. 

“So what we noticed was that, with elective surgeries being paused, there was a spike in Stage 4 colon cancer and a spike in Stage 4 breast cancer during that time,” he said. “And that’s well documented because people weren’t getting their specific screenings.”

Additionally, they had to provide critical care, including many urology procedures that involved placing stents, Flynn said. Although these were considered elective, delaying them could have led to severe complications, like sepsis, he added. 

“It was essential to get those cases done,” he said. “So, we continued to do those cases. We also continued to perform lumpectomies and simple mastectomies, which we could do in the surgery center, to avoid delays in the rest of the care – like radiation and other follow-up treatments – that are essential afterward.”

Later, when a COVID-19 resurgence led New York Gov. Kathy Hochul to halt elective hospital surgeries, she encouraged hospitals to collaborate with ASCs to continue essential care. This shift acknowledged ASCs as safe, vital options for patients wary of hospitals due to the pandemic. 

“By coming to a center like ours, they knew they wouldn’t encounter sick people or people being housed there,” he said. “It made people more comfortable to get their procedures done, and that was the case. Then we tried to continue the conversation, and we have, in terms of how we can save money.”

Flynn’s next order of business in New York is lobbying for more advanced cardiac procedures to be approved for the outpatient setting, another area that the pandemic created shifts in across the country. 

In Tennessee, where Sam Jones of the Chattanooga Heart Institute operates, more acute cardiac procedures are regularly performed in the outpatient setting, largely due to the shift caused by the pandemic. 

“Things really changed in 2020 when percutaneous interventions (PCIs), such as stent placements, were added to the CMS covered procedure list,” Dr. Jones previously told ASC News. 

Lessons in disaster preparedness

The experience of operating through COVID-19 has prompted many ASC operators to think more strategically about their role in future emergencies. 

The country needs a national disaster preparedness strategy that integrates ASCs as part of a broader health care response, Woodrow Moore, founder of the Texas ASC Society, told ASC News. 

“Where do ASCs fit within the incident command structure put in place after 9/11? I do not have the answer for that, other than that we are a safe, convenient location where elective procedures can be performed,” he said. 

He also pointed out that during past crises, regulatory adjustments allowed ASCs to collaborate with hospitals, in some cases functioning under hospital licensure to expand healthcare capacity. This temporary relaxation of regulations provided ASCs with more flexibility to support hospital systems when needed.

Indeed, in the wake of Hurricane Helene and other natural disasters, ASCs have played a role supporting hospital systems. 

But a nationwide IV fluid shortage is causing ASCs across the U.S. to postpone elective and non-urgent procedures, with heart ablations, tumor removals and colonoscopies among the surgeries affected. 

The crisis, sparked by Hurricane Helene’s damage to Baxter International’s North Cove plant in North Carolina – a facility producing 60% of the country’s IV solutions – has led health systems to conserve their limited supplies, pausing some outpatient surgeries to conserve IV fluid. 

Although their support of hospital systems is vital, operators said the crises reaffirmed their need to think about disaster preparedness, so their facilities can continue to operate and perform procedures even during times of emergency. 

“This is relatively new, but the most recent impact we’ve seen is some cases being shifted back to the hospital in order to save fluids for other types of cases at the ASC,”  Scott Bergman, market president at ASC development company Compass Surgical Partners, told ASC News. “Luckily, we haven’t had to cancel any cases yet, but we have seen a few shifts to the hospital. However, they’re also facing the same issue. Hopefully, this gets resolved quickly, but right now, it’s all about building stock and getting as much fluid in as possible.”