Coronavirus (COVID-19) Action Plan

The information provided on this website and in the podcast is not intended to be a comprehensive resource for all rules, regulations and standards that an Ambulatory Surgery Center must meet. The advice provided should not be considered as, nor does it constitute legal advice or opinion. When reviewing specific situations involving legal and regulatory issues, attorneys and other professionals should be consulted.

Action Plan

Here is a quick reference for actions you should be taking immediately
Apply for the Paycheck Protection Program through the Small Business Administration
There has finally been a lot more clarification on the Paycheck Protection Program and how to apply for it.  We now know that you should probably start with your local bank – assuming they are an approved SBA participant, or consider other local banks that are.  If you don’t have a banking relationship with such a vendor or choose to not use that bank, contact us John Goehle at 585-594-1167 and he will arrange a contact.
The Paycheck Protection Program provides small businesses with funds to pay up to 8 weeks of payroll costs including benefits. Funds can also be used to pay interest on mortgages, rent, and utilities.
Funds are provided in the form of loans that will be fully forgiven when used for payroll costs,
interest on mortgages, rent, and utilities (due to likely high subscription, at least 75% of the
forgiven amount must have been used for payroll). Loan payments will also be deferred for six months. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees.
In order to have the loan forgiven, you must keep the employees on your payroll or rehire them quickly and maintaining current salary levels.  Forgiveness will be reduced if full-time headcount declines, or if salaries and wages decrease.
Generally,  all ambulatory surgery centers are eligible, HOWEVER, the ASC Association has identified some issues related to ASCs that are affiliated with larger institutions.  If that is your situation, you may wish to visit the ASC Website at ascassociation.org as it becomes available as they are appealing to the SBA to correct an issue with the program implementation.
You can apply beginning Friday,  April 3, 2020.  Please apply as quickly as you can because there is a funding cap.
You should check with your current bank and/or lenders as many will be existing SBA lenders.  In addition, other regulated lenders will be available to make these loans once they are approved and enrolled in the program.   All loans will have the same terms regardless of lender or borrower.
Here is a high level overview of the program:
For more information directly from the SBA Website:
Consider a Loan Advance
If your situation if particularly difficult, you may request a loan advance of $10,000.  You will still have to go through the process listed above, but this is meant to provide immediate relief – and will take a few hours to complete the on-line application and to supply the supporting documentation. For more information go to this website at the Small Business Administration:
Ensure Your Infection Control Plan is Up to Date (Especially if you are remaining open)
Our Infection Control Plans will be scrutinized to a heightened degree following the COVID-19 pandemic. Even if you don’t have an upcoming survey, the legal consequences to remaining open without a proper infection control plan could be severe. If you aren’t staying open, your plans will still be looked at in the coming year by surveyors looking more closely at infection control. Be sure to include pandemic policies, emerging infectious disease policies, and temporary protocols including the screening, isolation, and COVID-19 addendum provided yesterday.
Complete/Continue Life Safety Testing and Maintenance documentation before you Close Down
 
We touched base with AAAHC, who gave guidance to ensure all documentation is compliant before you leave and then do proper testing when you return. For example, your biomedical testing/maintenance should be done when you return to the center, your refrigerators should be set up with a min/max thermometer (one that alerts you when it goes out of range is best), and any monthly/ quarterly maintenance should be resumed upon your return.
 
Prepare for Re-opening by the end of April (if currently closed or planning to close)
You should replace your Heating, Ventilation, and Air Conditioning Filters upon return to your center if you have had an exposure. Everyone else should still carefully consider replacing/cleaning their filters upon return since COVID-19 is considered prevalent in our communities.
Be prepared to have life safety testing resume upon your return to the center. This is particularly important if you are cancelling contracts or you have let them lapse due to contractors/staff not being on site.
Remember the following systems:
  • Electrical
  • Medical Gas
  • Vacuum System
  • Sprinkler
  • Fire Protection
  • Emergency Lighting
  • HVAC
  • Elevator (if applicable)
  • Biomedical
All non-patient care/support staff should be working from home or furloughed (in some states)
Check your state regulations.  The following is related to New York State specifically but your state might have similar guidance.
  • Only staff that should be onsite if you are doing surgery should be staff with direct support to active patient care for non-elective/urgent cases. This is only if the center has had a board meeting to determine how procedures would be determined to be not-elective/urgent. The physicians will need to complete a form for each case done to attest that it is a not-elective/urgent procedure. This is being enforced with fines and potential loss of license in New York State.
CONTACT YOUR ATTORNEY
 
There are many legal issues that you are most likely facing in the current environment.  Regular communications with your attorney about a variety of topics is essential.  In particular, you need to consult with an attorney about:
  • Employment practices
  • Continuing any Operations when a State Mandate to curtail non-essential operations or elective surgery
  • Contractual issues if you are required to pay for services that are unnecessary at the present time.

Critical Websites to Visit Regularly related to COVID-19

Resources for Recommendations and Mandates are:

Taking Care of Your Employees

Patient Screening and How to Handle an Exposure

Post Signs

Infection Control Policies Resources in Light of COVID-19

The Emergency Preparedness Plan

If you have to Shut Down or Curtail Elective Surgery

Connect with Us through the Podcast or Consider Services from Ambulatory Healthcare Strategies

  • Listen to the “ASC Podcast with John Goehle” on your iPhone “Podcasts” app or on Google Play on the Android
  • Visit Web Site at ascpodcast.com – you can also listen to the podcasts on the site.
  • Ask to Connect with “John Goehle” on LinkedIn
  • We are also on Youtube, Search for “John Goehle” on Youtube page – you will see our video and our audio podcasts.  We will start using YouTube Live with our next podcast.
  • We will most likely start using Facebook Live also – no details yet.
  • Consider supporting the podcast financially and get added benefits
  • If you need help, Ambulatory Healthcare Strategies is always available to help
  • If you need reference resources, buy John’s Books for more information about regulatory issues

Economic Issues (Possible Sources of Financial Relief):

Federal, CoronaVirus

The coronavirus response toolkit https://www.cdc.gov/coronavirus/2019-ncov/index.html            – Coronavirus Response Toolkit – CDC

US Chamber of Commerce – Resources to Help Your Small Business Survive the Coronavirus

https://www.uschamber.com/co/start/strategy/small-business-resources-for-surviving-coronavirus 

List of local Chambers of Commerce listed by state https://www.uschamber.com/co/chambers 

Tax Relief

  • “To offer tax relief during the coronavirus outbreak, the individual and corporate taxpayer will have an additional 90 days to pay their taxes.”

New York State, Specifically

https://www.governor.ny.gov/news/governor-cuomo-announces-three-way-agreement-legislature-paid-sick-leave-bill-provide-immediate “governor.ny.gov”

Cuomo Announces Three-Way Agreement with Legislature on Paid Sick Leave Bill to Provide Immediate Assistance for New Yorkers Impacted By COVID-19. Governor’s Program Bill Guarantees Job Protection and Pay for New Yorkers Quarantined as a Result of Novel Coronavirus. Legislation Also Adopts Comprehensive Paid Sick Leave Proposal First Advanced in Governor’s Executive Budget. Follows Governor’s Announcement Last Week that the State Will Provide Two Weeks Paid Leave for Quarantined State Workers.

The New York Small Business Development Center (NYSBDC) http://www.nyssbdc.org/Coronavirus.html General information for what individuals can do, symptoms to be on the lookout for, regarding COVID-19, see specifically “Additional Resources” at the bottom for Recommendations for Small Businesses 

NYC, only –

https://www1.nyc.gov/site/helpnownyc/index.page – General Page

https://www1.nyc.gov/site/sbs/businesses/covid19-business-outreach.page

Assistance & Guidance for Businesses Impacted Due to Novel Coronavirus. Mayor Bill de Blasio announced on March 8 that the City will provide relief for small businesses across the City seeing a reduction in revenue because of COVID-19. Businesses with fewer than 100 employees who have seen sales decreases of 25% or more will be eligible for zero interest loans of up to $75,000 to help mitigate losses in profit.

The City is also offering small businesses with fewer than 5 employees a grant to cover 40% of payroll costs for two months to help retain employees. Eligible owners who would like to learn more about these programs should fill out our interest form. 

(Link to page containing form.) https://www1.nyc.gov/site/sbs/businesses/covid19-business-financial-assistance.page

(Actual form link) COVID-19 Business Assistance Survey  https://www.surveymonkey.com/r/N336ZYB

https://therealdeal.com/2020/03/10/as-coronavirus-impacts-nyc-small-businesses-city-offers-financial-relief/

As foot traffic declines at New York City retailers and restaurants amid coronavirus fears, the de Blasio administration is stepping in to help small businesses stave off layoffs and closures. The city will offer businesses, with fewer than 100 employees, interest-free loans of up to $75,000, if they can demonstrate sales decreases of 25 percent or more, the mayor announced Monday.

https://www.nydailynews.com/coronavirus/ny-coronavirus-nyc-businesses-tax-collection-20200316-kc2epbbcljgtdhyjudhqjoutoi-story.html

A majority of NYC Council members are calling for the city and state to delay the collection of certain taxes from small businesses until the coronavirus pandemic is under control.

List of resources from article from Fasten Halberstam LLP (with direct links) (some repetition)

https://mailchi.mp/1a45feec5054/financial-resources-covid-19?e=567dcf67fc

SBA Disaster Loans

NYC Employee Retention Grant Program

NYC Small Business Continuity Fund


Previous Guidance


Economic impacts COVID-19 on small businesses. (ASCs) Economy slowing down, market fluctuations, government mandates on types of cases.  impacts due to potential for lower case loads. There are options and resources available

    • United States Small Business Administration
    • Visit SBA.gov

Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19)

https://www.sba.gov/page/guidance-businesses-employers-plan-respond-coronavirus-disease-2019-covid-19

Economic Injury Disaster Loan Program

The SBA will work directly with state Governors to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19).

Go to:  SBA.gov/Disaster

Common Issues Small Businesses May Encounter:

    • Workforce Capacity
    • Inventory and Supply Chain Shortfalls
    • Facility Remediation/Clean-up Costs
    • Insurance Coverage Issues
    • Changing Market Demand
    • Capital Access – Incidents can strain a small business’s financial capacity to make payroll, maintain inventory and respond to market fluctuations (both sudden drops and surges in demand). Businesses should prepare by exploring and testing their capital access options so they have what they need when they need it.
    • See SBA’s capital access resources

Access to Capital

SBA provides a number of loan resources for small businesses to utilize when operating their business. For more information on loans or how to connect with a lender, visit:https://www.sba.gov/funding-programs/loans.

Local Assistance

SBA works with a number of local partners to counsel, mentor, and train small businesses. The SBA has 68 District Offices, as well as support provided by its Resource Partners, such as SCORE offices, Women’s Business Centers, Small Business Development Centers and Veterans Business Outreach Centers. When faced with a business need, use the SBA’s Local Assistance Directory to locate the office nearest you.

https://www.sba.gov/local-assistance