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.
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.
- Medical Gas
- Vacuum System
- Fire Protection
- Emergency Lighting
- Elevator (if applicable)
- 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.
- 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
- CDC – Information for Healthcare Providers – COVID-19
- CMS Current Emergency Portal
- CDC COVID-19 Travel Notices (Updated)
- CDC Guidance for Healthcare Facilities – COVID-19
- CDC Infection Control Recommendations – COVID-19
- CDC Guidance for Management of Exposed Healthcare Personnel
Resources for Recommendations and Mandates are:
- American College of Surgeons – Recommendations for Management of Elective Surgical Procedures
- JOINT GI SOCIETY MESSAGE: COVID-19 Clinical Insights for Our Community of Gastroenterologists and Gastroenterology Care Providers
- Massachusetts Order to Cease Non-Essential Invasive Procedures
- NYC DOH Guide for Infection Control in Outpatient Setting During Community Transmission (Quick Guide – Might be useful to centers outside of NYC)
- City of New York Mandate
- New York City Mayor Executive Order Ceasing all Some Surgery (Based on Patient Risk)
- See #6. All ASC’s must move to cancel or postpone elective procedures and cease performing such procedures within 96 hours of the issuance of this order. ASC’s are directed to identify procedures that are deemed “elective” by assessing which procedures can be postponed or cancelled based on patient risk considering the emergency need for redirection of resources to COVID-19 response.
Taking Care of Your Employees
- Remind employees to stay home if they are sick or have flu symptoms
- Consider requiring employees that have traveled to affected areas to self-quarantine
- Consider taking temperature of employees upon arrival for work to screen for potential issues
- Example Letter to Employees
- Manage Anxiety for Healthcare Workers (Updated 3/19)
- Health Advisory: Protocols for Personnel to Return to Work Following COVID-19 Exposure(This is from NYS – But useful elsewhere also – Updated 3/19)
- The decision to Furlough versus Layoff (Consult your Attorney for More Information:
There are a lot of questions about the differences between a furlough and laying off staff. We have been working with our friends at Cohen Compagni Beckman Appler & Knoll, PLLC and they have a great post at:
During a furlough an employee cannot do any work, including taking phone calls. If you ask the employee to do any functions, including taking phone calls, the employee would most likely lose unemployment benefits and would have to be paid by you. Non-Exempt employees would be required to be paid the hourly rate, exempt employees would be paid their full pay. A periodic email to the employee about the status of the operations is probably all right.
- NYS Specific – What you Need to Know about NYS and Federal Leave Laws
- NYS Sick Leave Guidance
- Department of Labor Guidance on Employee Paid Leave
Patient Screening and How to Handle an Exposure
- Call all patients prior to day of surgery and ask screening questions. Encourage to stay home if they have symptoms.
- COVID-10 Generic Protocol (Updated 3/19)
- COVID-19 Protocols (CT)(Updated 3/19)
- COVID-19 Protocols (FL)(Updated 3/19)
- COVID-19 Protocols (NY)(Updated 3/19)
- COVID-19 Protocols (NYC)(Updated 3/19)
- COVID-19 Protocols (OH)(Updated 3/19)
- COVID-19 Protocols (PA)(Updated 3/19)
- COVID-19 Protocols (TX)(Updated 3/19)
- Attachment A – Screening Decision Tree (Updated 3/19)
- Attention Visitors Sign
- Stop the Spread of Germs
- Coronavirus Sign
- NYC-Travel Triage Poster
- NYS-Attention Visitors Sign
- NYS-Coronavirus Sign
Infection Control Policies Resources in Light of COVID-19
- Emerging Infectious Disease Policy 3-12-20
This is the reference to the EPA guidance regarding the use of cleaning products. Anything on this list can be used against COVID-19. Search your products in the table below, by EPA Registration Number which can be found on the product label.
- COVID-19 Addendum IC Policy (Cases)
- COVID-19 Addendum IC Policy (If you become a Testing Site)
The Emergency Preparedness Plan
- Pandemic Policy (For Emergency Preparedness Plan)
- 1135 Waiver Policy (Updated 3/19)
- COVID-19 Drill Kit
- Part of your emergency plan should be to reach out to both your local municipality’s emergency and health department and your local hospital to remind them of your availability. Here are two examples of letters that you can send, email etc.
- Investigate Options for Becoming a Testing Site
- Consider Financial Ramifications and Potential for Relief:
If you have to Shut Down or Curtail Elective Surgery
- Hold a Board Meeting to Document Decisions as to what is Elective
- The following are example Emergency Board Meeting Minutes if you are under NYC Orders:
- The following are example Emergency Board Meeting Minutes for any situation where you limit the types of procedures:
- The following are example Emergency Board Meeting Minutes for facilities in Ohio under their Order:
- If You Decide to Perform Non-Elective Procedures, use a form to document
- The following is a form to use to document the decision to perform a non-elective procedure:
- If you decide to shut down, determine if you have to notify the state.
- Prepare for the Aftermath (What to do while closed)
- If you are in New York State – and you wish to stay open, we recommend you apply for an exception
- File an Exception
If you need assistance determining your region:
- File an Exception
- Keep a log of cases that are cancelled to prove that you are not scheduling and performing elective procedures.
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):
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
List of local Chambers of Commerce listed by state https://www.uschamber.com/co/chambers
- “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
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
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.
(Actual form link) COVID-19 Business Assistance Survey https://www.surveymonkey.com/r/N336ZYB
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.
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)
SBA Disaster Loans
NYC Employee Retention Grant Program
NYC Small Business Continuity Fund
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)
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.
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.