Across the country, ophthalmic ASCs have been scrambling to adapt within the COVID-19 crisis and what seems to be an ever-evolving news cycle regarding updated legislation and ever-changing recommendations on best practices. They’re struggling with decisions on how to best modify ASC operations while still serving patients’ needs, taking care of employees, and staying financially solvent.
What follows is the latest information (at press time) from the Outpatient Ophthalmic Surgery Society (OOSS) regarding strategies and resources for navigating the evolving crisis its unprecedented challenges.
Payroll and Cash Flow
At press time, one of the biggest pieces of news was the Centers for Medicare & Medicaid Services (CMS) announcing relief for clinicians, providers, and facilities participating in Medicare quality reporting programs. That includes the 1.2 million clinicians in the Quality Payment Program. CMS will be granting exceptions from reporting requirements and extensions to participating clinicians and providers.
“This will allow providers to receive advanced, accelerated payments over the next several months in respect to what they’ve been budgeting for—and then back-pay as they file claims with a 200-day pay-off period,” says Michael Romansky, Washington counsel and vice president for corporate development at OOSS. “This comes as a relief and is great news for ASCs who are in need of immediate cash flow. This will be an important avenue for them beyond Small Business Administration (SBA) loans they may also be considering.”
This news comes on the heels of the Families First Coronavirus Response Act (FFCRA), passed March 18 with an effective date of April 1, which requires private employers with fewer than 500 employees to provide special paid emergency family and medical leave and paid sick leave in certain COVID-19-related circumstances, to be offset by refundable payroll tax credits. In terms of employer coverage exceptions, the U.S. Department of Labor has the authority to issue regulations that ex-clude small businesses with fewer than 50 employees each, if the FFCRA’s requirements would jeopardize the viability of the business.
Romansky says that in addition to understanding recently passed legislation, ASC owners also want to know whether they will qualify for SBA loans. The $2 trillion federal coronavirus relief package known as the CARES Act includes $350 billion for a small business loan program called the Paycheck Protection Program (PPP). PPP loans are designed to help provide cash flow assistance through 100% federally guaranteed loans to employers who maintain their payroll during this emergency. If employers maintain their payroll, loans will be forgiven. This will help workers remain employed while also helping small businesses fully restart operations as quickly as possible.
The size of the loan is 250% of an employer’s average monthly payroll cost during the period Feb. 15, 2019 to June 30, 2020, capped at $10 million. Loans will be made through eligible FDIC lenders.
ASCs seeking a quick infusion of a smaller amount of cash to cover them right away might want to look into the Economic Injury Disaster Loan (EIDL). These grants provide an emergency advance up to $10,000 to small businesses harmed by COVID-19. The advance can be used to keep employees on payroll, pay for sick leave, meet increased production costs, pay business obligations like debts, or make rent and mortgage payments.
More information on these loan programs can be found at sba.gov/funding-programs/loans/coronavirus-relief-options .
Impact on Operations, Staff
There’s no question that ASCs have been hit hard by the COVID-19 pandemic. Many have been forced to reduce hours or close—either through necessity or by their individual state’s pandemic response plan.
According to an informal survey of OOSS members done just prior to press time, 42% of ASCs were retaining personnel, 39% were furloughing employees, 19% were implementing layoffs, and 7.7% were enacting pay-reduced hours, reports Diane Blanck, executive director of OOSS.
Some of the biggest worries echoed among ASC physicians and owners have been about their staff.
Supply and Demand
We are hearing stories from healthcare providers in COVID-19 hot spots that PPE supplies are running out, affecting not only medical personnel in hospitals caring for COVID-19 patients, but all medical offices that are instituting extra measures of protection so they can continue to see urgent and emergent cases. If you’re in need, those screens, masks, and other supplies may be available from unconventional sources.
Equipment vendors. Several diagnostic equipment vendors have offered after-market adaptations—such as plexiglass screens—for their ophthalmic exam equipment to protect providers when “social distancing” from patients is impossible. Check with your vendors to see what may be available.
Other industries. In communities across the country, fabrication companies and other industries have turned to making goggles, shields, and masks. An example is 3D printing company Matterhackers, which is making PPE and other protective supplies free for medical personnel, including those in vision care.
matterhackers.com/covid-19
—Susan Tarrant
“Clearly, ASCs want to retain and treat their staff fairly,” says Blanck. “The CARES Act may help them to do so. Thus far, it appears that the physician-owners are financing payroll as a first option, with SBA loans as a second solution. The PPP will provide much needed support for ASCs.”
At press time, approximately 84% of ophthalmic ASCs reported that they were mostly closed, only performing procedures deemed emergent, according to OOSS survey data. Those ASCs that remained open for select procedures were primarily seeing retina and cornea cases followed by cataract and glaucoma cases—as well as emergencies, such as retina detachments.
“ASCs are in the midst of trying to figure out how to take care of emergent cases,” Blanck says. “They can play a vital role in keeping patients out of hospitals, but it’s no easy feat to close down an ASC and still take on emergency cases as needed. These are uncharted waters and it’s safe to say that most are worried about how long the closures will last. For now, the ASCs are focused on caring for patients with emergent needs, keeping their staff safe, retaining their teams, and helping the medical community at large with local support, such as personal protection equipment, ventilators.”
Going forward, OOSS will continue to interpret and share with members timely news, directives, and guidelines from Washington.
“We work with other ophthalmic and ambulatory surgery associations to amplify our voice and advocacy,” she adds. “We are collaborating with our strategic partners in order to develop resources, such as webinars and tangible planning tools, to help ASC physician-owners and administrators navigate their short-term challenges. For example, just this week, we collaborated with Progressive Surgical Solutions, a division of BSM Consulting, on a series of webinars addressing steps to take in temporarily closing your ASC as well as financial projections to support your business decisions. Communication is key to staying connected with our members, partners, and communities, and we utilize a multimedia approach to connecting with our members.”
Despite the current unknowns, OOSS and its members remain cautiously optimistic.
“Concurrent with short-term implementation, our members remain hopeful and resilient, focused on the reopening the ophthalmic ASCs when it is safe and appropriate,” Blanck says. “OOSS and our members are grateful for our colleagues and all first responders on the front line of the crisis.” ■
Ophthalmic Resources
Looking for advice and direction regarding this ever-changing situation? A great place to see an updated collection of news reports and web links is the Ophthalmology Management magazine website: ophthalmologymanagement.com . In addition, The Ophthalmic ASC has collected these resources to help you stay up to date on restrictions, legislation, and best practices.
Webinars
Best Practice Recommendations
At press time, many centers were still struggling with the decisions of how long to stay open, what kind of cases to accept, and what staffing decisions would be fairest to both the center and the employees. For those still grappling with those kinds of decisions, the following links may help.
Financial/Legislative Updates
—Susan Tarrant
![]({"src":"/media/hgsozajm/cover_omd_0520.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})