Ambulatory surgery centers concerned about new state order restricting elective surgeries

BOSTON MA. – MARCH 10: Gov. Charlie Baker listens as Health and Human Services Secretary Marylou Sudders speaks at an availability at the State House to address the state’s response to the coronavirus on March 10, 2020 in Boston, MA. (Staff Photo By Nancy Lane/MediaNews Group/Boston Herald)
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BOSTON – Although the Baker administration has said several times that its new order halting elective medical procedures would not apply to outpatient care, the state’s ambulatory surgery centers worry the actual policy does not line up with the descriptions offered.

Health and Human Services Secretary Marylou Sudders stressed Tuesday that, unlike a similar halt on elective treatments officials ordered in the spring, preventive visits such as colonoscopies and mammograms can still take place.

But Greg DeConciliis, who leads the Massachusetts Association of Ambulatory Surgery Centers, told the News Service that the state guidance still leaves gaps that could block patients from getting key outpatient care.

“If you have a family history of colon cancer and I was your doctor who was on your colonoscopy, I could make the case that you need to have your colonoscopy, that it’s essential you have your colonoscopy at this time because you have a family history,” DeConciliis told the News Service. “But if I don’t have a medical history of colon cancer, I would be delayed because I’m not an essential case. I can still get a mass.”

The public health order requiring postponement of non-essential elective invasive procedures, which takes effect Friday, applies to both hospitals and to ambulatory surgical centers, though Sudders said on Monday that “ambulatory outpatient surgeries could continue.”

By once again pushing off some non-essential medical work, the Baker administration is hoping to free up additional hospital capacity and qualified staff to help cope with the rising COVID-19 threats.

Only about 23 percent of the state’s non-ICU hospital beds remained open and available as of Monday, according to DPH data, down from 34 percent available just one week earlier.

Gov. Charlie Baker warned Tuesday that 11 hospitals across the state have fewer than 10 percent of their adult in-person beds remaining available.

“Let me be clear: this is a limited curtailment of elective procedures to promote the redeployment of staff that perform non-essential, elective procedures to support the essential and urgent in-patient medical care,” Sudders said Monday. “It is not a blanket, across-the-board curtailment that we implemented in the first surge. Ambulatory services, preventive care such as mammograms, colonoscopies, children pediatric check-ups and the like, may continue to be available.”

In DeConciliis’s view, though, state health officials are flattening incongruous parts of the health care system into a single policy.

“We seem to get lumped into this when we should be looked at as different animals,” he said.

The 58 ambulatory surgery centers in Massachusetts are specialized facilities designed to offer outpatient procedures where patients do not need to stay overnight. Unlike hospitals, DeConciliis argued, they do not have resources that can be directly reallocated toward COVID care.

Staff at the ASCs would not be able to move into COVID-related settings easily — DeConciliis said the centers’ surgical nurses would require significant training to shift into an intensive care unit.

“They’re trained to deal with surgical patients, not with medical issues from COVID on the floor in an ICU,” he said. “It would be like saying ‘shut down the nursing homes in Massachusetts, send all the patients, all the residents back to whoever their caregivers are, and send all those nurses from the nursing home over to care for ICU patients.’ “

Elective procedures are a key income source for many sections of the health care industry, and DeConciliis forecast that their delay will “100 percent” carry a financial hit for ambulatory surgery centers.

“I was surprised that I don’t think we lost anybody in April and May,” he said. “I don’t know if they’ll be able to survive the second time around. We just don’t have any other ancillary income.”

Also Tuesday, tn the wake of the latest step on elective procedures, the Massachusetts Nurses Association called for implementation of a “universal N95 masking standard” to help prevent asymptomatic virus spread. All frontline health care workers should receive a new N95 respirator at the start of each shift, the union said.

“The state’s rapid increase in COVID-19 cases, high rates of asymptomatic spread, continued inadequacy of healthcare worker testing and the elevated risk of workplace exposure demand that all frontline nurses and healthcare professionals be provided N95 masks,” MNA President Katie Murphy said in a statement. “Having an N95 mask is and always has been the scientific standard for caregivers exposed to COVID-19. The federal government weakened PPE guidelines early in the pandemic not because the science changed but due to inadequate supply chains, poor planning, and political expediency.”