Becker's Spine Review

38 OUTPATIENT SURGERY CMS to require prior authorization for cervical fusion with disc removal By Alan Condon C MS will use prior authorization to reduce un- necessary increases in the volume of covered outpatient spine services next year. Beginning July 1, 2021, CMS will require prior autho- rization for cervical fusion with disc removal as well as implanted spinal neurostimulators. The strategy aims to ensure Medicare patients receive necessary care, "while protecting the Medicare Trust Funds from unnecessary increases in volume by virtue of improper payments, without adding new documen- tation requirements for providers," the agency said in a Dec 2. announcement. n How a 2nd round of elective surgical delays will affect ASCs — 5 administrators share insights By Eric Oliver A s increasing COVID-19 case counts shut down elective surgical programs across the U.S., five administrators shared their thoughts with Becker's ASC Review on what the shut- downs could mean for their centers. Note: Responses were edited for style and content and are presented al- phabetically. Suzi Cunningham, administrator of Advanced Ambulatory Sur- gery Center in Redlands, Calif.: e current surge we are seeing here in California and across many states right now is very concerning. Our center has implemented strict protocols so we can safely continue to provide much needed orthopedic care to patients in our communi- ty while also providing a safe environment for our staff, patients and providers to work. Since a shutdown did happen earlier this year, we know this is a real possibility. e impact of this [will be] far-reaching as people who are in extreme pain are forced to wait for surgery and in some cases with long-lasting health implications. If we are able to remain open, we can take the pressure off of the local hos- pitals by caring for their trauma cases, not to mention being able to provide a means for our staff to continue to work and provide for their families. Robert Lerma, administrator at Blue Springs Surgery Center in Orange City, Fla.: What I have seen in the media and at our center is that an elective procedure a patient would normally have chosen to correct a medical condition prior to the COVID-19 pandemic, is now deferred. In certain cases, it is only those procedures that are emer- gent in nature that are being chosen by the patient. e older patient may have medical issues that may be further com- plicated with the induction of anesthesia or procedures that are more invasive, which may result in a longer procedure time in the operating room. ose procedures unless emergent, are sometimes being delayed. Our surgeons are spending more time educating our patients that an ASC is just as safe now as in pre-COVID-19 times. Furthermore, there are extra precautionary steps that ASCs have implemented to minimize the risk of spreading the virus: • e wearing of masks by our staff • Social distancing within the ASC space • Preoperative COVID-19 testing • Continuance of hand-washing and all other aseptic techniques that were used prior to the COVID-19 pandemic I anticipate COVID-19 spikes reducing surgical procedure volume within our ASC, and our challenge is to educate our patients on the extra precautionary steps we have taken to maximize their safety. Bonnie Brady Lavoie, RN, vice president of operations at West Morris Surgery Center in Succasunna, N.J.: If elective procedures are closed down again for spikes, then we expect to see decreased volumes. However, if they close electives for hospitals only, then ASCs can benefit from providing care to those patients for emergency care. In New Jersey, we were allowed to care for those emergent elective procedures during the last spike. Some centers did not follow the gov- ernor's executive order and continued to do those procedures that may not have been emergencies and reported volumes stayed the same or increased. at should not be the case if you were compliant. For centers following the orders, we would probably see a decrease in volume but will stay compliant for the safety of patients and staff. Joleen Harrison, BSN, RN, administrative director at Mankato (Minn.) Surgery Center: With the spike in COVID-19, we anticipate patient volumes to decrease some. We are uncertain of how many. Minnesota is in a four-week shutdown. ... We have [a] 50 percent or- thopedics [case mix] which this [shutdown] could impact with fewer sports injuries. e other deciding factor is those that may be without jobs and lose healthcare coverage. [For patients losing] either, it may become cost prohibitive to have a surgical procedure. We have started to see more patients cancel or delay with a COVID-19 exposure who are either quarantining or are out with COVID-19. Our surgery cen- ter hopes COVID-19 numbers decrease with the new executive order in place. We wish for all to stay safe in the next weeks to come. Raghu Reddy, administrator at SurgCenter of Western Maryland in Cumberland: Our community is experiencing a higher infection rate than the rest of the state at the moment. e hospital has opened a tent-based triage unit and additional COVID-19 units to accommodate the steep increases in community infections. We have canceled several days in the past week due to staff shortages and anticipate that the cancellations could continue intermittently until the infection rate is low again. We are also ex- periencing a shortage of N95 masks and a few other types of personal pro- tective equipment, which has become a significant challenge. Fortunately, our hospital partner is assisting us with this situation, and we are doing our best to protect everyone while performing the cases. Overall, during this pandemic, except for the mandated shutdown, our ASC volume has fared better than we expected. However, the recent surge is imposing our case volume due to closures. We are in constant communication with the health department and the hospital regarding the community spread and patient and staff testing, and plan the center's operations accordingly. n

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