Member Focus Archive

Title: Administrator
Facility Name: Boston Out-Patient Surgical Suites
City: Waltham
State: Massachusetts
Length of time your facility has been an ASCA member: Five or more years

Do you have a policy on GLP-1 medications and how long before surgery they should be stopped?

GLP-1 receptor agonist medications have quickly become a significant issue with our preadmission nursing team. We have found an abundance of patients on these medications, not only for the benefit of weight loss, but also diabetics who receive a benefit from this medication. The action of delayed gastric emptying led us to a strict policy of inquiry regarding these medications in prospective patients. Patients who are prescribed the injectable form must stop injections a minimum of seven days prior to surgery. Patients who are on the oral form must stop at least 48 hours prior to surgery.

Our anesthesia team is very strict with these policies due to the increased risk of aspiration in these patients. Due to the length of time they need to be off of these medications, discovering a patient is on one of these medications the day before surgery would lead to a cancellation and the loss of an extremely valuable OR slot. Our facility provides a preoperative questionnaire to our surgeons' offices that contains a general list of key medical history “red flags” for scheduling a patient at our facility. We have added the use of GLP-1 receptor agonist medications, listed by name, to this questionnaire, which can be filled out by the patient quickly while in the office. By having this critical information immediately, it can provide useful information regarding their health history and any action that must be taken regarding that history.

Do you employ residents? If yes, what are your criteria and policy?

Our facility does not employ residents; however, we are affiliated with a fellowship program. Surgeons affiliated with the sports medicine department utilize fellows based on their availability. In order to facilitate compliance, we have an affiliation agreement with the employing hospital and the sports medicine program. This agreement outlines both parties' responsibilities for the program, including credentialing, supervision and liability insurance. We credential our fellows as any other surgeon who requests privileges at our facility; however, our fellows have strict rules and guidance as to what their limitations are in practicing at our facility. For the fellows, our facility offers the dream scenario of a highly efficient setting where they can maximize their exposure to sports medicine surgeries. This type of program, however, has the downside of any other teaching program, as “teaching procedures” can often take longer than “non-teaching procedures.” The upside of this type of program could be your surgeons having more time to spend in between surgeries, or possibly “flipping cases” to another room, as you essentially have an additional extremely qualified surgeon with the ability to set up a procedure or close the procedure for the attending surgeon.

Title: Director of Operations
Facility Name: Amsurg
City: Miami
State: Florida
Length of time your facility has been an ASCA member: Two years

Do you have a policy on GLP-1 medications and how long before surgery they should be stopped?

Most of the centers have a policy in place, but each treatment and surgical plan is specialized to the patient's needs. Our physicians and surgical centers follow the American Society of Anesthesiologists recommendations to hold therapy the day before and to hold for a week if undergoing weekly treatment. This has been an ongoing discussion given GLP-1's increase in usage, and many quality studies are still being conducted.

Do you employ residents? If yes, what are your criteria and policy?

We don't employ residents but we do have physicians and surgery centers that participate in residency programs. As a company, we value education development and engaging our upcoming physicians with real-life scenarios in medicine. There are contracts for GME collaborations that specifically lay out who is to hold insurance and oversight responsibility. The center keeps a board-approved center policy and patients' consent to residents being present. Similar to a credentialing file, all information for each resident is reviewed, approved and retained through quality and governance committees. I would be interested to see how some of your other members participate in this process.

Title: Administrator
Facility Name: Advanced Ambulatory Surgery Center LLC
City: Evansville
State: Indiana
Length of time your facility has been an ASCA member: Five or more years

What are the top three goals for your ASC this new year?

Goal #1 for my ASC is for our employees in the billing department to obtain the Certified Professional Coder (CPC) certification, as this is the gold standard for medical coding. Individuals who earn the CPC credential have proven expertise in physician/nonphysician provider documentation review, abstract professional provider encounters, coding proficiency with CPT, HCPCS and ICD-10, and compliance and regulatory requirements for physician services. Second to this certification would be for our billing department to undergo a coding and billing audit performed by an independent contractor to ensure compliance with established billing and coding practices.

Goal #2 for my ASC is to become accredited by AAAHC and, hopefully, followed by Medicare Deemed Status accreditation. My ASC consistently performs well on both state and federal surveys, but AAAHC accreditation would certainly raise the bar for our employees, physicians and, most importantly, our patients.

Goal #3 for my ASC is to develop a well-defined succession plan for key positions, i.e., administrator, nurse manager, CFO, etc. I believe preparing people for future roles is important to support continuous business functioning. Succession planning is a long-term, strategic investment that buffers businesses against inevitable future disruptions or sudden job vacancies. The goal of succession planning is to ensure employees can assume new positions with confidence and poise.

How are you handling increased anesthesia costs?

We use a CRNA two days a week, but only for MAC procedures. We do not do general anesthesia at all. Most of what we utilize the CRNA for are pain injections, i.e., radiofrequency ablation procedures. We pay him a stipend for the days he works with us. That’s really the only anesthesia cost we incur, and we recoup most of that by billing for anesthesia services when possible.

Title: Administrator
Facility Name: Pain Care Surgery of Louisville
City: New Albany
State: Indiana
Length of time your facility has been an ASCA member: Less than one year

What are the top three goals for your ASC this new year?

As my team and I navigate the very recent purchase of our ASC, our goals have shifted slightly. First, we will need to ensure that all licensure, certifications and accreditations are in place for the new center. Next, we will need to ensure that all staff are trained and prepared for the expansion of our approved surgical procedures list to ensure quality care and positive outcomes for patients. Lastly, our main goal remains to bring high-quality surgical care to our patients at reasonable costs while ensuring job satisfaction and fulfillment for the ASC employees.

How are you handling increased anesthesia costs?

Our ASC offers a myriad of anesthesia options for our patients. Our physicians work with our patients to determine the anesthesia needs. We care for patients with all levels of anesthesia needs, from local injections to general anesthesia. We partner with contracted anesthesia professionals to deliver quality care to our patients. We schedule patients strategically to ensure efficient use of the anesthesia provider's time. Patients who do not require the presence of an anesthesia provider are scheduled together and cared for by highly qualified nurses. There is no avoiding rising anesthesia costs. Compensation, supplies and drug costs continue to soar. However, strategic scheduling and a variety of anesthestic options help us to continue to deliver safe care without incurring an astronomical increase in costs.

Title: Executive Director of ASCs
Facility Name: Commonwealth Pain & Spine
City: Louisville
State: Kentucky
Length of time your facility has been an ASCA member: Five or more years

What are the top three goals for your ASC this new year?

The top three goals for my ASCs are: 1) Achieve Medicare-deemed status and AAAHC accreditation for our new locations. 2) Educate and train our surgeons and clinical teams to perform higher-acuity cases safely and efficiently in the ambulatory setting with reproducible quality outcomes. 3) Increase patient access to our services in the correct site of service at a lower out-of-pocket expense.

How are you handling increased anesthesia costs?

Each of our ASC locations will have a customized approach to managing our anesthesia spend. Some locations will rely on partnerships with CRNAs, while others, supporting higher-acuity cases, will partner with anesthesiologists who are ready, willing and able to sit their own chair and actively provide direct patient care. Charging ASCs anesthesia stipends or subsidies are shortsighted and not sustainable; ultimately, the patients stand to lose.

Title: Administrator
Facility Name: Precision Care Surgery Center
City: East Setauket
State: New York
Length of time your facility has been an ASCA member: Two years

What are the top three goals for your ASC this new year?

We are coming to the close of our first three years of operation and it has been a whirlwind adventure.

Our primary goals for this year are to pass our reaccreditation survey, increase outpatient access to total shoulder surgery for Medicare patients and lastly, but most importantly, continue to provide excellent care to our patients.

We will continue to implement new technologies to help streamline processes and effectively communicate with our patients. We want to aid in keeping ASCs on the forefront of healthcare.

How are you handling increased anesthesia costs?

Very well. We are fortunate enough to have a favorable payer and case mix so that our anesthesia group does not require a stipend. I am sure should things take a downturn, a stipend would come up for discussion, but at this time we are working hard to at the very least maintain our current payer and case mix.

Title: Administrator
Facility Name: Red Hills Surgical Center
City: Tallahassee
State: Florida
Length of time your facility has been an ASCA member: Five or more years

What are the top three goals for your ASC this new year?

The top three goals for our facility in the new year are: building expansion, physician recruitment and inventory management. We are currently a multispecialty facility with five operating rooms. Over the last five years, we have seen a steady growth of both our community and our medical staff membership. With the continued growth, we recognize that the need for more ORs is upon us and have plans to expand our facility to include three additional operating rooms beginning this year. We also recognize that although our medical staff membership continues to increase in size, it is also aging. The need to continue to recruit new members is vital in the long-term health of the organization. Lastly, with continued growth comes increased supply costs and challenges. Our goal for 2024 is to reduce the stagnant inventory on our shelves through more organized storage, more accurate usage tracking and better utilization of our procurement and EHR software.

How are you handling increased anesthesia costs?

Our facility has been very lucky in regards to the cost associated with anesthesia. With robust case volumes and quality payer mixes, we have yet to see the subsidy requirements many facilities around the country are facing. Although we may not yet be experiencing the increases associated with anesthesia staffing, we have continued to struggle with curbing the ever-increasing costs of supplies. In order to help manage those costs, we have relied heavily on our medical director, who happens to be our director of anesthesia, to guide us on what new medications or supplies are necessary for quality care versus the fads of the moment. Quite frankly, it is a struggle that we continue to work and have yet to find a great answer. We believe that physician involvement is key when making the determination of what is needed versus what is wanted. We will continue to use the expertise of our medical director and key members of our medical staff to help guide us to informed decisions on how and where we can find those cost savings in the new year.

Title: ASC Nurse Manager
Facility Name: Peachtree Orthopaedic Surgery Center North
City: Cumming
State: Georgia
Length of time your facility has been an ASCA member: One year

How do you celebrate the holidays at your ASC?

We typically have events where the staff gets involved. This year, we are doing the 12 days of Christmas. Each day will be something fun planned for the staff, such as a gift card hunt, ornament exchange, cookie swap and a winter potluck. We use this time to give back to our local community. We have a giving tree for families in need and a Santa paw tree for our local animal shelter. We also are hosting a canned food drive for a local organization. The feedback from the staff has been positive and they enjoy getting involved.

How do you handle vacation requests during the holidays?

I try my best to be fair about it. For example, if a staff member was off last Christmas, then they are not given first priority for getting this Christmas off. I also ask staff to turn in their holiday time off request well in advance so I can begin to plan. I usually ask for requests to be turned in by September.

Title: Executive Director
Facility Name: Knoxville Orthopaedic Surgery Center
City: Knoxville
State: Tennessee
Length of time your facility has been an ASCA member: Five or more years

How do you celebrate the holidays at your ASC?

We love celebrating our employees! Thanksgiving is our time to do our annual employee appreciation gift as we celebrate, "We are Thankful for You!" This year, our staff received a nice pullover with the facility's logo. We also do a Thanksgiving catered lunch.

December starts our annual physician sponsored lunches! We have 9–10 days in the month where we have catered lunches for the staff provided by our amazing physician owners. One of our physicians does a soup day where he makes his delicious homemade soups and brings them to the center. This is no small feat because we are feeding 140 people! We also give our staff members their annual bonus in December.

In addition to all of this, we also like to give back! Over the years, we have adopted angel tree children, silver bell elderly adults and various Christmas families, and the staff buys Christmas gifts for them. We love the holidays at KOSC and we love our staff!

Title: Director of Education and Clinical Process Improvement
Facility Name: Atlas Healthcare Partners
City: Phoenix
State: Arizona
Length of time your facility has been an ASCA member: Four years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

Our physicians are required to complete a minimum number of cases within a specified time frame in order to maintain privileges. All of our credentialed providers are required to be recredentialed every two years from their initial date of appointment to our medical staff. Active staff consists of physicians who are regularly involved in the care of patients in the centers. The volume of annual cases necessary to achieve and maintain active status is 12 cases per year or 24 cases prior to reappointment. This allows the centers to complete ongoing evaluations to determine clinical competency.

In order to maintain privileges, an Ongoing Professional Practice Evaluation (OPPE) is performed to evaluate clinical processes and outcomes, as well as identify opportunities for professional performance improvement. The centers provide OPPEs each year to the Medical Executive Committee and the governing board for review and reappointment after the two years.

Do you audit your janitorial and housekeeping staff? For what purpose?

We have monthly infection prevention audits that help to ensure that the centers maintain a safe environment of care for our patients. In addition to this monthly audit, our housekeeping team documents the cleaning that is performed daily.

Title: Administrator
Facility Name: Deerpath Ambulatory Surgical Center
City: Morris
State: Illinois
Length of time your facility has been an ASCA member: Five or more years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

My center does not have a minimum case number. Since the majority of our surgeons are investors, they are required to do at least one-third of their eligible cases at the surgery center.

Do you audit your janitorial and housekeeping staff? For what purpose?

We have a checklist that the janitorial staff follow. This provides a system of checks and balances for the cleaning of the center. If an item was marked as complete and not done, then we are able to go back to the company and resolve the deficiency.

Title: Chief Executive Officer/Administrator
Facility Name: Total Surgery Center
City: Naples
State: Florida
Length of time your facility has been an ASCA member: Five or more years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

One may require a minimum number of cases to be performed to maintain membership and privileges to show that a physician is invested in the center. This would strictly be a “maintain membership” question. We currently do have a minimum number for our nonphysician owners to maintain membership. If a physician has ownership, then the number is stipulated and governed by the Stark Law and Anti-Kickback Statute, ensuring that the surgery center is an extension of their practice.

However, to maintain a particular “privilege” or “privileges,” this should be tied to a continued ongoing measurement of competency measuring quality and safety of performance of a particular procedure. At our center, we have specific criteria delineated on each privilege form, which decides how many cases a physician has to perform during the reappointment period to be able to be considered competent, based on objective criteria decided on by the governing body.

This will allow a baseline to measure ongoing clinical competency. If the physician has not performed that minimum threshold criteria at the surgery center, ongoing clinical competency may be proven by verifying that the procedure is being performed at other locations, like other facilities or the hospital. If this cannot be demonstrated, the governing body has data to be able to handle each case and provide options, for example, proctoring requirements, to allow a physician to continue to perform a particular type of surgery at the facility.

Do you audit your janitorial and housekeeping staff? For what purpose?

We have a log to ensure the cleaning has been performed. It is audited periodically to ensure that all infection control protocols are followed.

Title: Administrator
Facility Name: Munster Surgery Center
City: Munster
State: Indiana
Length of time your facility has been an ASCA member: One year

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

Yes, at our ASC, we require our surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges. The two main specific requirements are, first, a minimum number of cases where surgeons must complete a minimum of 10 cases per year to maintain their privileges at our ASC. Second is the time frame, where this minimum number of cases is assessed annually, starting from their initial credentialing or reappointment date. We have implemented these requirements to ensure our surgeons maintain their skills and expertise, provide high-quality patient care and stay current with their fields' latest advancements. These requirements align with industry standards and best practices for maintaining surgical privileges in ASCs. Surgeons who do not meet these requirements may undergo a review process to determine the appropriate course of action, which may include additional training or a reevaluation of their privileges.

Do you audit your janitorial and housekeeping staff? For what purpose?

Yes, we audit our janitorial staff because it serves multiple crucial purposes. It ensures patient safety, compliance with regulations, effective infection control, operational efficiency and a positive reputation.

Patient safety is the top priority for ASCs. The cleanliness of the environment directly impacts patient health. Auditing your janitorial service helps ensure that all areas within the ASC, from waiting rooms to operating suites, are maintained in a sanitary condition. Regular audits can identify areas that require improvement and ensure that cleaning protocols are followed meticulously.

ASCs are subject to strict regulatory standards set forth by organizations like CMS and AAAHC. Auditing your janitorial service can help confirm that your facility meets these rigorous cleanliness and infection control standards.

Infection control is critical, particularly in a surgical setting. Auditing your janitorial service helps monitor the effectiveness of infection control protocols. It ensures that high-touch surfaces, equipment and patient areas are adequately disinfected, reducing the risk of healthcare-associated infections that can have severe patient consequences.

A clean and well-maintained ASC contributes to patient safety and enhances operational efficiency. Auditing your janitorial service helps you identify any inefficiencies in the cleaning process and can lead to cost-saving measures. It ensures that cleaning resources are used optimally and that janitorial staff is well trained.

The reputation of your ASC can significantly impact patient satisfaction and, consequently, your bottom line. Patients and their families expect a clean and comfortable environment. Auditing your janitorial service ensures that these expectations are consistently met, enhancing your ASC's reputation and improving patient satisfaction scores.

Title: RN Manager
Facility Name: Sansum Clinic Pueblo Surgery/Gastroenterology Department
City: Santa Barbara
State: California
Length of time your facility has been an ASCA member: Five or more years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

We do not require our providers to do a minimum number of cases as we are a single-specialty unit. We currently do 700-plus procedures every single month.

Do you audit your janitorial and housekeeping staff? For what purpose?

Janitorial and housekeeping are contracted services from our corporate offices. As you know, there is a standard in AAAHC [2.I.I.], which refers to the review of all contracted services by the governing body. Therefore, it is one of the goals of our organization to ensure these services are reviewed and reported to the governing body.

2.I.I. states that the governing body is responsible for approving and ensuring compliance of all major contracts or arrangements affecting the medical and/or dental care provided under its auspices.

Title: Administrator
Facility Name: Bend Surgery Center
City: Bend
State: Oregon
Length of time your facility has been an ASCA member: Five or more years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

We do not, however, we require that each licensed practitioner document their education, training and experience, indicating a continuing ability to provide quality patient care services. Indication of volume of cases performed at other facilities would be considered in evaluating ongoing competence. The Medical Executive Committee could request additional documentation to demonstrate current professional competence as well.

Do you audit your janitorial and housekeeping staff? For what purpose?

We have both internal and contracted environmental service crews. We have checklists and overall monitoring on a daily, monthly and quarterly basis dependent on different areas within the facility. These checklists serve as audit tools to utilize in overall quality control management. We also utilize findings within those checklists as educational areas for improvement, as well as having an organized checklist to keep standards of our cleaning accessible to all members of our EVS [environmental services] team.

Title: Chief Executive Officer
Facility Name: Copper Ridge Surgery Center
City: Traverse City
State: Michigan
Length of time your facility has been an ASCA member: Five or more years

Do you require your surgeons to complete a minimum number of cases within a specified time frame to maintain their privileges? How many cases and over what period of time?

We do not have a requirement for surgeons to complete a minimum number of cases to maintain their privileges. However, our peer review process is different for providers who have not performed any cases when it is time for their reappointment. We just transitioned our credentialing and reappointment timeline to not exceed a three-year period; previously this was two years.

Do you audit your janitorial and housekeeping staff? For what purpose?

We are fortunate to have a good, longstanding relationship with our housekeeping services and can easily communicate any concerns. We are collaborating with the staff on updating some of our daily and weekly checklists, which are always available for review.

Title: Clinical Director
Facility Name: Surgery Partners
City: Brentwood
State: Tennessee
Length of time your facility has been an ASCA member: Five or more years

Tell us about your experience with administering the OAS CAHPS Survey and what you have learned from the responses you received.

Implementing this survey early has been huge for our facilities and has allowed us to learn and improve as we worked through problem areas. For example, there were particular questions regarding nausea/vomiting, pain and bleeding that had not been previously asked on our surveys and these were almost always low-scoring areas. We learned that we needed to develop specific discharge education around these topics. This was a larger issue for single-specialty pain management and ophthalmology centers since postoperative issues like bleeding weren't typically an issue that needed to be addressed with patients in these specialties.

As we improved on areas that were easier issues to tackle, we moved on to more complex issues we found, such as increasing response rates. Employee understanding of the survey and its importance is crucial to success also. The more you include your employees in solutions for solving problem areas, the more engaged they are. This in turn helps increase both response rates and overall scores.

How do you work with patients who do not speak English? Do you use language line services or an interpreter, or another kind of service?

Our facilities use a contracted vendor to provide interpretation services. The vendors also provide document translation services, so we use them to translate important documents, such as consent forms. This allows us to share documents with our patients in their preferred language.

Title: Administrator and Chief Executive Officer
Facility Name: Covenant High Plains Surgery Center
City: Lubbock
State: Texas
Length of time your facility has been an ASCA member: Five or more years

Tell us about your experience with administering the OAS CAHPS Survey and what you have learned from the responses you received.

We are not currently administering OAS CAHPS, we are using a short-form survey.

How do you work with patients who do not speak English? Do you use language line services or an interpreter, or another kind of service?

The vast majority of non-English-speaking patients in our region speak Spanish, and we have a number of nurses and other staff members who are fluent in Spanish. We do encounter the occasional patient who has different language needs, for which we have a contracted telephone interpreter service—a language line—that can also arrange for in-person sign language interpreters as needed. Lastly, of course we respect the patient’s wishes if they prefer to use family members.

Title: OR Manager
Facility Name: Southeastern Spine Institute and Ambulatory Surgery Center
City: Mount Pleasant
State: South Carolina
Length of time your facility has been an ASCA member: Five or more years

Tell us about your experience with administering the OAS CAHPS Survey and what you have learned from the responses you received.

Patients always remember kindness and compassion. If you can connect with your patients, you earn their loyalty and respect. People are always quicker to give negative feedback, so if you engage and connect with your patients you get a truer picture in the feedback you receive.

How do you work with patients who do not speak English? Do you use language line services or an interpreter, or another kind of service?

We are fortunate to have a multilingual anesthesiologist who works well with our non-English-speaking patients. If we encounter a patient who speaks a language that the anesthesiologist doesn’t speak and the patient doesn’t have an English-speaking family member or friend, we do use the language line. But we have found that a real person eases a patient’s anxiety.

Title: RN
Facility Name: Ohio Specialty Surgical Suites
City: North Canton
State: Ohio
Length of time your facility has been an ASCA member: Three years

How do you work with patients who do not speak English? Do you use language line services or an interpreter, or another kind of service?

In our ASC, we have used both a language line and in-person interpreters. Both of these services have worked great for our patients and the patients have had positive experiences with both.

Title: ASC Director
Facility Name: OSMC Outpatient Surgery Center
City: Elkhart
State: Indiana
Length of time your facility has been an ASCA member: Five or more years

Now that the COVID-19 PHE has ended, what kind of masking requirements are you following in your center?

We no longer require masking of patients or staff in our facility. We still screen all our patients before surgery, and staff are not allowed to work if they are sick.

How do you waste expired medication—not narcotics—at your facility?

We waste all expired medication into a drug buster container.

Title: Senior Consultant
Facility Name: Progressive Surgical Solutions
City: Gallitzin
State: Pennsylvania
Length of time your facility has been an ASCA member: Five or more years

Now that the COVID-19 PHE has ended, what kind of masking requirements are you following in your center?

We follow CDC guidelines, which until recently were based on the community transmission metric. Now that this metric has ended, we are not masking in our facility because we are low risk. All patients are screened preoperatively for illness and staff are asked not to report to work when sick. We found that the state guidelines often align with the CDC.

How do you waste expired medication—not narcotics—at your facility?

Medications should be wasted according to any manufacturer instructions and state guidelines. If expired medications are not exchangeable or returnable, we dispose of them in a pharmaceutical waste container.

Title: Chief Administration Officer
Facility Name: Bone and Joint Surgery Center of Novi
City: Novi
State: Michigan
Length of time your facility has been an ASCA member: Five or more years

Now that the COVID-19 PHE has ended, what kind of masking requirements are you following in your center?

We have made masking optional in all areas outside of the operating room.

How do you waste expired medication—not narcotics—at your facility?

We use Rx Destroyer for all of our expired medications.

Title: Clinical Director
Facility Name: Congress Medical Surgery Center LLC
City: Pasadena
State: California
Length of time your facility has been an ASCA member: Five or more years

Now that the COVID-19 PHE has ended, what kind of masking requirements are you following in your center?

Masks must be worn in patient care areas by staff, MDs, etc. Patients are not required to wear masks but are encouraged. Masks do not need to be worn in nonpatient areas, such as in the lounge or medical records area.

How do you waste expired medication—not narcotics—at your facility?

We send them out to ReturnCo Inc., a pharmaceutical reverse distribution company.

Title: Chief Executive Officer
Facility Name: University Ambulatory Surgery Center
City: San Diego
State: California
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

We do not employ AHPs, however we do credential them like our other providers. They are typically employed by the physician and assist them for all of their surgical cases. I find it is usually orthopedic physicians who require a PA, especially on their more complex cases like total joints. Since the PAs are credentialed, they are peer reviewed like our physicians and competencies are addressed during their credentialing cycle.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

We do not bill for anesthesia services at our center; we have an agreement with a local anesthesia group. A pro to this arrangement is that we do not have to be involved in collecting the fee for the service. A con is that some of our patients get confused when they don’t understand there will be a separate bill from them. We try our best to educate our patients ahead of time to help avoid any issues.

Title: Chief Operating Officer
Facility Name: Carolina Interventional Pain Institute LLC
City: Columbia
State: South Carolina
Length of time your facility has been an ASCA member: One year

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

Absolutely! Allied staff are an integral part of our team. We are a two-OR, one-procedure room facility. We employ certified surgical technicians who are key players in our OR spaces, in addition to radiologic technicians who are a vital part of our team providing precise and adequate fluoroscopy imaging for physicians during procedures. All of our staff members require annual competencies in addition to required continuing education credits. For our radiologic technicians, we do provide annual radiation safety training, and for certified surgical technicians, annual infection control training.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

No, we do not bill for anesthesia services; we utilize individual contractors, both anesthesiologists and CRNAs. The pro for our method is we are able to vet the staffing for the ORs, which leads to continuity for staff and excellent patient care. The con for this method is there is not a large pool to pull from that we would otherwise have with large anesthesia groups. This challenge makes it difficult to find replacement coverage for leaves of absence for illness or vacation, especially on short notice. We remain in a very tight market with anesthesia services in our region.

Title: Administrator
Facility Name: Baylor Scott & White Surgicare Denton
City: Denton
State: Texas
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

No, they are credentialed like our surgeons.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

We do not bill for anesthesia; the providers bill for their services. The pros are that we don't have to worry about collecting money for another service and the anesthesia group collects after the procedure, so the patient doesn't have to come up with additional money upfront. I don't know of any cons at this point.

Title: Regional Administrator
Facility Name: Northwest Georgia Orthopaedic Surgery Center and East West Surgery Center
City: Marietta
State: Georgia
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

Yes, we employ certified first assists to augment our certified surgical techs and, of course, our circulators. We credential our providers' physician assistants. The surgery staff complete annual competencies. The credentialed staff complete an initial competency. The practice of the employment model has been well received by our providers.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

No, we do not bill for anesthesia services, we have an outside contract. The pros for our contract method are that we are not responsible for staffing or liability. The con is lack of coverage, which is getting more prevalent.

Title: Administrator
Facility Name: Corpus Christi Outpatient Surgery
City: Corpus Christi
State: Texas
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

Our allied health team includes physician assistants, surgical technicians, certified nurse anesthetists, intraoperative neuromonitoring technologists and others as required by our governing board. They provide services within their scope of practice to provide quality care to our patients by enhancing our surgical team. We involve our medical executive committee and nursing and administrative leadership teams when determining initial and ongoing competency.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

Anesthesia services at our facility are a contracted, professional service. Our contract provides coverage and service expectations and is evaluated annually to determine if those expectations are being met or need modifications. The contracted vendor is responsible for all billing and collecting of fees associated with anesthesia services. One expectation is that the vendor is in network with the majority of our primary insurance companies in our market.

Title: Administrator
Facility Name: Baylor Scott & White Sports Surgery Center at The Star
City: Frisco
State: Texas
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

Allied health professional staff are credentialed providers. We do not employ allied health professional staff.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

Anesthesia providers are credentialed to our staff, they are not employed by the facility and/or contracted by the facility. Anesthesia services are billed by the independent provider. The biggest pro of this relationship is physician satisfaction with choice of anesthesia providers to provide services for their cases. Another pro includes the fact that the scheduling of anesthesia is performed at the physician's office. Typically, the surgeon uses the same provider week after week, therefore, we are still able to create the structure and processes needed at the facility.

Just as there are pros to this relationship there are cons as well. Some cons include that many different providers from different groups are in our facility daily. This relationship can cause delays in surgery related to the changes throughout the day. Unfortunately, this relationship can also lend itself to political issues with hand-off communication and staying at the facility to wait for the appropriate discharge status of the patient by one provider when another provider from a different group is still at the facility. Unfortunately, this also leads to many different anesthesia providers being credentialed at the facility. The majority of the time the number of anesthesia credentialed providers is more than quadruple the number of surgeons credentialed to the facility.

Overall, this is not a one-size-fits-all arrangement. Facility leaders can work with many different types of arrangements and what works best at one facility might not work best at another facility.

Title: Administrator
Facility Name: Orthopaedic Institute Surgery Center
City: Metropolis
State: Illinois
Length of time your facility has been an ASCA member: Five or more years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

We have CSTFAs, RNFAs and PAs, all credentialed to assist surgeons in the operating room. None of these providers see patients at the center for physical assessment or documentation purposes. All of the above assist in surgery. They are initially credentialed and do have an annual performance review completed by the surgeon they assist. They also complete annual center training in infection control and emergency preparedness.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

We do not bill for the professional component of anesthesia services at the center. Our anesthesia providers are contracted through an outside group. We do bill for the facility fee for their procedures, for example, for the preop block. The pro of not employing anesthesia providers is in not dealing with the headache of staffing and covering the schedule/vacations, etc. We are very happy with this arrangement as the CRNAs are still very involved and engaged in the center.

Title: RN Director
Facility Name: SurgCenter of Western Maryland LLC
City: Cumberland
State: Maryland
Length of time your facility has been an ASCA member: Three years

Are allied health professionals part of your staff? What services do they provide, and how do you determine their competency?

Several allied health providers, consisting of LPNs, RNs and surgical techs, assist physicians on their block day. These providers assist the surgeon in performing duties such as retracting, suturing and passing instruments. They have a yearly peer review performed by our full-time staff, who work alongside them and can fairly assess their competency. The providers also review the center's policies on infection control, sexual harassment, the disaster plan, quarterly and annual drills, radiation safety, HIPAA and risk management annually. These allied health providers are the backbone of our surgery center. They embrace our safety culture, put in a personal effort to learn new skills each day and wear different hats to make us very effective in delivering high-quality care.

How do you bill for anesthesia services? Under your billing info or separately for a contracted anesthesia group under their info? What are the pros and cons of your method?

We do not bill for anesthesia services. Since our inception, a contracted provider has staffed our anesthesia department and bills for their employees/contractors. The center has no involvement in their billing, nor does the contracted vendor have any investment in our surgery center. Based on their credentials, we have a say in which providers we wish to have at the center. Due to legal compliance and OIG recommendations, and given the complex nature of this service, our board has always kept the anesthesia service outsourced to a third-party company that handles all our day-to-day anesthesia through their employees and contractors. We have been experiencing gaps in coverage and subsidies that the ASC industry has never heard of. Even if we wanted to employ our own anesthesia staff for more control, as stated, the complex legal requirements are tricky to navigate, and we would always be on the hook for anesthesia revenue cycle management. Anesthesia employment by the center does not come highly recommended by legal experts at the moment; if any center does it, there has to be a lot of transparency on the whole process to remain compliant.

Title: Executive Director
Facility Name: Hunterdon Center for Surgery
City: Flemington
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

Do you have an RN in a procedure room when anesthesia is providing sedation and a tech is assisting the MD? Why or why not?

Yes. The nurse monitors the patient and provides comfort to the patient. It is especially important since the patient is not under general anesthesia and may feel alone and scared. The nurse is there to always advocate for the patient.

In a multispecialty center, how do you do peer review? Do you have a similar specialty do the review or similar licensed professionals?

We were cited by AAAHC for not having this review done by a similar specialty. Basically, the medical director was dinged based off of information given by the director. We have changed our process now and have a champion in each specialty who reviews that specialty.

Title: Chief Nursing Officer
Facility Name: Community Surgery Center of Glendale
City: Glendale
State: California
Length of time your facility has been an ASCA member: Four years

Do you have an RN in a procedure room when anesthesia is providing sedation and a tech is assisting the MD? Why or why not?

Yes, when we have anesthesia cases in the procedure rooms, we always have a registered nurse in the room with the MD and the tech.

The registered nurse is a critical team member with a number of responsibilities in major or minor cases. The RN in the procedure room is ensuring that the patient is safe, the surgical/procedure team has what they need, that anesthesia is supported, and that the documentation in the patient chart is completed, capturing the critical portions of the procedure. Even in minor cases, there is always the risk of an adverse reaction to the procedure or anesthesia, and having an RN in the room is the best way to ensure that patients are provided with an RN advocate and that patient safety is maintained.

In a multispecialty center, how do you do peer review? Do you have a similar specialty do the review or similar licensed professionals?

As a multispecialty center, we ask for specialties with multiple physicians to perform peer review on their same specialty. For specialties with fewer physicians, we ask similarly credentialed specialty providers to perform the peer reviews. For example, vascular may be peer reviewed by cardiology or general surgery. Ultimately, if there is a question or an issue not resolved by the similarly credentialed provider, it would get escalated to the medical director and likely an outside physician reviewer in the same specialty.

Title: Chief Nursing Officer
Facility Name: Ambulatory Healthcare Strategies
City: Lake Clarke Shores
State: Florida
Length of time your facility has been an ASCA member: Three years

In a multispecialty center, how do you do peer review? Do you have a similar specialty do the review or similar licensed professionals?

Peer review of the medical staff and credentialed providers is conducted in an ongoing manner and review is performed by peers. An anesthesiologist may review a CRNA, but a CRNA cannot review an anesthesiologist.

If there is only one provider in a specialty in the center, the peer review should be done by an individual review board (search online sources), or arrangements can be made with other centers' providers. Consider HIPAA and confidentiality concerns.

Can someone from a different specialty review a peer (another MD)? This is not ideal, as they may not know the indications for surgery for that specialty. The forms should delineate if this is part of the review.

Criteria for review should be developed with input by the medical staff, and it should be meaningful to the specialties provided in the center. Peer review is not a medical chart audit for documentation, etc. It also is not nursing peer review.

The results of peer review should always be used for recredentialing consideration. Surveyors will look for documentation that the board has seen the recommendation for reappointment. On initial applications, peer references serve as peer review.

Title: Clinical Director
Facility Name: Amsurg
City: Okatie
State: South Carolina
Length of time your facility has been an ASCA member: Three years

Do you have an RN in a procedure room when anesthesia is providing sedation and a tech is assisting the MD? Why or why not?

The centers I work with each have different staffing models. When considering staffing procedure rooms, it is important to review and understand state regulations, accreditation guidelines and any professional guidelines you have chosen to follow. Interestingly, CMS does not provide strong guidance related to staffing procedure rooms. When staffing a procedure room, we consider the experience and skill of the team along with the complexity of the procedure. We utilize a multidisciplinary team to create an efficient and safe environment.

In a multispecialty center, how do you do peer review? Do you have a similar specialty do the review or similar licensed professionals?

Peer review is conducted by a provider with the same license, e.g., a urologist peer reviewing a urologist. Some general surgeons perform colonoscopy, so it would be appropriate to have a gastroenterologist conduct peer review for those cases. A CRNA can peer review another CRNA but not an anesthesiologist; however, an anesthesiologist can conduct peer review for a CRNA. If there is a conflict of interest or you do not have another provider with a similar license on the medical staff, you may be able to contract with a local hospital or a third-party vendor to provide peer review.

Title: ASC Clinical Director
Facility Name: Missoula Bone & Joint Surgery Center LLC
City: Missoula
State: Montana
Length of time your facility has been an ASCA member: Five or more years

How do you prep your staff for a survey?

Our leadership structure, teamwork and quality/risk management program consistently keep us prepared for unannounced surveys. Our ASC leadership team, which includes the surgical technologist/sterile processing supervisor, the OR supervisor, the preop/PACU supervisor, the pre-admission/extended recovery supervisor and the ASC clinical director, meets weekly to check in, collaborate and discuss any issues in our respective areas. Patient safety and clinical excellence are at the core of our discussions. These weekly check-ins keep us survey ready in addition to our quarterly quality/risk management meetings that this same team participates in to review all metrics that we consistently track and look for ways to continually improve. In addition, we meet as a team to specifically review previous survey requests and to determine where to find answers in the event a surprise survey happens when any one of us are on vacation or are absent.

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

Our ASC procedure for patient follow-up does include RNs phone calling every patient we see. We have a list of questions we ask the patients pertaining to pain control, nausea, bleeding, swelling, voiding, bowel function, drains, fever, DME equipment, nerve blocks, follow-up appointments, etc., so that we can answer all patient questions and make appropriate referrals. We document these follow-up phone calls and include if we leave messages. We attempt to reach patients two times postoperative to ensure they have adequate discharge instructions and no questions for us until their follow-up visits with our providers.

Title: Chief Administrative Officer
Facility Name: SurgCenter of Western Maryland LLC
City: Cumberland
State: Maryland
Length of time your facility has been an ASCA member: Three years

How do you prep your staff for a survey?

We operate every day as if there is going to be a surveyor present. We ensure strict adherence to our policies and procedures and the regulations/standards for Medicare and AAAHC certifications. Our manual of policies and procedures is modeled after the AAAHC handbook, making it very easy for staff education and compliance. We also review the AAAHC, state and CMS manuals annually. During our staff meetings, we provide ample opportunities for Q&As, quizzes, etc. Communication regarding policy and procedure changes is the key to compliance. We expect the staff to know what compliance standards are in their respective departments. They may not answer to every area, but the more education, the better. We encourage honesty and sincerity if they do not know the answers to the questions. Our nurse manager gauges the pulse throughout the year for the new hires regarding their understanding of compliance standards and provides guidance and additional education as needed.

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

We give out two questionnaire forms, one for feedback and one for postop, with a pre-stamped envelope when the patient leaves the facility. The patients mail in both the forms. Because the postop questionnaire has the patient label, it is separated from the feedback form in the business office, so that the person evaluating the feedback forms doesn’t get to see the patient details. We call the total joint patients only or any specially identified patients. We keep a log of all the total joint patients and the call status.

Title: Administrator
Facility Name: Ambulatory Care Center
City: Vineland
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

How do you prep your staff for a survey?

Prepping for a survey is an ongoing process. Staff engagement, education and competency training are one way to truly be prepared for an unexpected survey—and we encourage our staff to take the lead on choosing timely topics, researching and facilitating in-services. When questions arise about quality or delivery of care issues, we point to regulations and standards as guidance for best practices. Team input is invaluable, too. During staff meetings, we ask if there are areas of concern or opportunities for improvement. Our center is accredited and our agency offers resource tools, such as a list of all documentation requirements, worksheets and toolkits to help member organizations stay “survey-ready.” Of course, when we are in the “survey window,” we review any deficiencies received on previous surveys to make sure that they have been addressed as outlined in the plan of correction and review any new guidance. It’s also a good time to schedule your life safety, infection control and pharmacy consultant visits.

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

Our center has moved away from the traditional “day after” postop phone call. Sixty-six percent of our patients respond to an electronic survey that asks questions about pain, bleeding, nutrition and mobility, and allows the patient to request a call from the nurse. The survey is sent out at 10:00 in the morning after the procedure and responses are uploaded with the patient’s chart. Patients who have opted out or not responded by mid-afternoon are called. Our policy is to attempt to reach the patient three times, and each is documented on the callback sheet. During the preop interview, we ask the patient’s permission to text, leave a voicemail or speak with a family member. The callback sheet has checkboxes to tick whether a voicemail was left or if a family member took the message, as well as the date and time for the phone call. Utilizing the electronic system has eliminated hours of nursing time and money playing phone tag. Additionally, many of our patients are back to work or school the day after a procedure; the electronic system allows them to answer at their convenience.

Title: Administrator
Facility Name: Cool Springs Surgery Center
City: Franklin
State: Tennessee
Length of time your facility has been an ASCA member: Five or more years

How do you prep your staff for a survey?

I prep my staff for a survey by always operating under survey ready conditions. We do not just do the right thing when it is time for a survey, we make survey preparedness part of our daily routine. In addition, during staff meetings throughout the year, we provide reminders for best practices, and then the week before an announced survey, we send out a series of reminders just for good measure.

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

We call our patients on the next working day following their procedure. If unable to reach them, we document this directly on the postop phone call form. We also send them a card thanking them for choosing our center. The card contains our contact information and asks them to reach out to us with questions, concerns or comments.

Title: Preop/PACU Nurse Manager
Facility Name: Bedford Ambulatory Surgical Center
City: Bedford
State: New Hampshire
Length of time your facility has been an ASCA member: Five or more years

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

After a patient has a surgical procedure, our policy is to call them the following business day, preferably before 11:00 am, to try and address any questions or concerns or detect any possible complications early. We have found this to be very helpful, especially for the patient. But also, we can identify any trends and modify accordingly. If we do not reach the patient on the first attempt, it is written in our policy to make a second attempt on the second business day. We keep an active call log of all the attempts and/or phones calls with a patient. It's as detailed as, "leaving voicemail," "speaking with the patient or loved one," "no answer," etc. Ultimately, if we do not reach a patient after two business days, we mark them as "unable to reach." If for some reason they do call back after that time period, we can always make changes to that section.

Title: Senior Director of Clinical Services
Facility Name: Amsurg
City: Nashville
State: Tennessee
Length of time your facility has been an ASCA member: Five or more years

How do you prep your staff for a survey?

Personally, I have always prepped my facilities by doing our best to keep survey-ready on a daily basis. I try to do annual audits or center assessments to help the center stay on top of it all. One of my focuses when a survey is coming up: I ask the center administrator and the management team to go through the survey manual, page by page, and answer each line item. I feel this helps you learn more about the process and keep in a survey-ready position. I would also always recommend that if you are going with AAAHC that you use the Deemed Status manual as it will keep your center ready for the unannounced CMS survey.

What is your postop phone call policy? Do you keep a log of the number of times you call if unable to reach a patient?

Most of my centers try at least three calls to reach the patient or their representative. This is then documented on the postop call sheet located in the chart. The call sheet has a place for the staff member to mark their initials on it to indicate if they left a voice message or if they were able to make contact. The sheet also has a line item to have the staff member remind the patient that they will be getting a survey on patient satisfaction and to ask them to please take it.

Title: Administrator
Facility Name: Mid-Atlantic Surgery Pavilion
City: Aberdeen
State: Maryland
Length of time your facility has been an ASCA member: Three years

How do you manage vacation requests? Do you have staff bid for vacation, have a calendar for sign-up or a different process?

Our center utilizes a calendar approach. We ask that no more than two employees within the same job classification take the same week off. We encourage our employees to begin populating the calendar in the beginning of the year. We do always try to oblige vacation requests. If it becomes an issue where three employees in the same classification want the same week off, we try to cover it. If we cannot cover it, we try to compromise either a change on their part or, as a last resort, deny the request. The vacations are written on a large calendar in the lunchroom where everyone can see them at all times. For special weeks, such as the week after Christmas or spring break, we rotate them annually if we have several people asking for the same week off. For example, the same nurse would not have the week after Christmas off two years in a row, unless no one else has requested it.

What paging system do you use and how well does it work? An overhead system, walkie-talkies, a phone system or something different?

Our center is small, so we basically do not utilize a paging system. We handle things the old-fashioned way and find that we do get our steps in.

Title: Executive Director
Facility Name: Surgical Care Center of Michigan
City: Grand Rapids
State: Michigan
Length of time your facility has been an ASCA member: Don't know

How do you manage vacation requests? Do you have staff bid for vacation, have a calendar for sign-up or a different process?

I have a yearly calendar in my staffing book and my team members write their vacation/PTO requests in that book. When I am doing staffing for the month, I review the requests and do my best to honor them. I am fortunate to have some part-time employees who are willing to pick up extra days to help cover vacations. My staff is required to put their PTO into DayForce (our electronic time card system) and then I approve it, so their PTO shows up on their time card and then in their paycheck.

What paging system do you use and how well does it work? An overhead system, walkie-talkies, a phone system or something different?

Our phone system is our paging system and it is OK as long as you are close to the phone. Our phone system is Mitel from First Tel. We also have a nurse call system for patients to use.

Title: Administrator
Facility Name: The Surgery Center
City: Middleburg Heights
State: Ohio
Length of time your facility has been an ASCA member: Five or more years

How do you manage vacation requests? Do you have staff bid for vacation, have a calendar for sign-up or a different process?

You must remember that sometimes even the “best plans” will go awry. We have two big year-at-a-glance calendars, one for the current year and one for the coming year, that hang on the bulletin board. A time-off request must be done in writing and once that is approved, the request goes on these calendars. One surgical assistant, one RN and one OR technician can be off at the same time. That all works well and good until someone has a death in the family or someone resigns and then your entire schedule is screwed up. It’s the nature of the beast being an ASC because we do not have “extra people” hanging around “just in case.”

There is something we have done as it relates to everyone requesting to be off during holidays, and believe me, it has been one of the best ideas we have ever come up with. Although initially skeptical, our surgeons love it too.

Anytime a holiday is on a Monday, we close the Friday before so that our team has a four-day weekend and we don’t start cases on that Tuesday until 9:00 am. We close the Wednesday before Thanksgiving and the Friday after. We also close on December 23, 24 and 26.

You might think about “lost cases” but there are none. Surgeons don’t want to receive calls on a holiday weekend and, quite frankly, over the years, the number of people wanting to “waste” a holiday weekend for recuperating from surgery has gone by the wayside.

A recent article talked about four-day work weeks. While I don’t believe we can accomplish that in our ASCs, these occasional long weekends have done a lot for overall team morale and give us all a chance to regroup, without everyone asking for vacation during holidays.

Title: Director of Nursing
Facility Name: Castle Rock SurgiCenter
City: Castle Rock
State: Colorado
Length of time your facility has been an ASCA member: Five or more years

What paging system do you use and how well does it work? An overhead system, walkie-talkies, a phone system or something different?

We use a system that pages over the phone. We have a few overhead speakers installed as well. It works well if it is used per our phone IFU. We try not to page a lot as we use Microsoft Teams to do most of our communication, or a phone text depending on who we need to contact. Our center is walkable, so if we need to connect we can simply walk to the area or person. We use walkie-talkies only in our emergency preparedness setting.

Title: Clinical Director
Facility Name: Marion Surgery Center
City: Ocala
State: Florida
Length of time your facility has been an ASCA member: Five or more years

What is your policy, protocol or algorithm for BMI and patient selection?

To be eligible for surgery at our facility, the policy is that the patient cannot have a BMI greater than 45 or be more than 100 pounds overweight. However, patients who exceed the BMI or weight thresholds can be evaluated by the surgeon and the anesthesiologist for approval by exception. These cases are determined on a case-by-case basis.

In addition, exceptions can be made based on the type of anesthesia that is being administered. Under local anesthesia, patients with higher BMIs can have procedures performed at the ASC after the anesthesiologist has reviewed the case to determine if the candidate’s risk factors would compromise patient safety and the delivery of medical care.

Title: Business Office Manager
Facility Name: Marion Surgery Center
City: Ocala
State: Florida
Length of time your facility has been an ASCA member: Five or more years

How do you determine your capital equipment budget?

The capital equipment budget is performed on an annual basis after a needs assessment has been discussed with the leadership team based on the current and projected surgical cases at the facility. In addition, after the proforma has been completed with an ROI determination, the draft capital equipment budget is formulated. The final capital equipment budget is submitted for approval or denial by the board of managers after consideration of all the key factors, most importantly our focus on the delivery of high-quality medical care.

Title: Administrator
Facility Name: Riverside Outpatient Surgery Center
City: Columbus
State: Ohio
Length of time your facility has been an ASCA member: Five or more years

What is your policy, protocol or algorithm for BMI and patient selection?

For patients receiving general, spinal or epidural anesthesia, we accept BMI of 45 or less. Our absolute weight limit is 500 pounds for all patients, ASA I, II or III. For patients higher than ASA III, we have our surgeons and anesthesiologists consult.

How do you determine your capital equipment budget?

We evaluate upcoming services on a case-by-case basis and also consider an equipment’s end-of-life.

Title: Director of Clinical Operations
Facility Name: Indiana University Health Bloomington Endoscopy Center
City: Bloomington
State: Indiana
Length of time your facility has been an ASCA member: Five or more years

What is your policy, protocol or algorithm for BMI and patient selection?

Our center is primarily focused on endoscopic procedures that require minimal levels of sedation. Patients who are larger than 350 lbs, have a history of opioid use, have implantable devices, have a history of needing higher sedation levels, are on home oxygen, have poor mobility, and/or have an infectious disease requiring isolation are scheduled at the endoscopy department at our partnering hospital.

How do you determine your capital equipment budget?

Our center is part of a larger health system and our capital equipment process is completed on a regional level. The system sets capital budgets for each region based on upcoming strategic projects in the next three to five years. Near the beginning of the third quarter in the current fiscal year, any capital items to be purchased for the following year have to be submitted to a capital committee with a full business plan and quote from the vendor. After initial assessment by the committee, projects are prioritized based on need for all requesting areas. Toward the fourth quarter in the current fiscal year, capital projects are approved for the following year. Upon approval, departments can utilize capital dollars for approved projects in the first quarter of the capital year. Any capital items needed outside of the normal review cycle have to be submitted to the finance department and executive team with a completed pro forma to determine return on investment and how the project improves operational performance.

Title: Emeritus Board Member
Facility Name: Idaho Ambulatory Surgery Center Association
City: Rexburg
State: Idaho
Length of time your facility has been an ASCA member: Five or more years

How do you determine your capital equipment budget?

This is what has worked well at a multispecialty center I once led. At least annually and usually at the end of the year:

• ask all providers for capital equipment requests;
• compile a list with estimated expenses;
• add in 6–8 percent to the total for overage, inflation or miscellaneous items; and
• take to GB for line-by-line approval/denial/pend.

Title: Executive Director
Facility Name: Hancock Surgery Center
City: Indianapolis
State: Indiana
Length of time your facility has been an ASCA member: Five or more years

What is your policy, protocol or algorithm for BMI and patient selection?

We currently do not have a policy for extreme BMI patients. The protocol is to determine the patient's overall health, comorbidities and weight, and present the information to the medical director for their determination if the patient's procedure can be performed safely in an ASC. If not, the patient is transferred to the hospital for their care.

How do you determine your capital equipment budget?

The executive director in conjunction with the finance director review the requests and determine the dollar amount needed for the next year.

Title: Administrator
Facility Name: Arkansas Valley Surgery Center
City: Cañon City
State: Colorado
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

We make them understand that we cannot bill until they have completed their paperwork. We are a small center, so the doctors, who are also owners, are motivated to complete their work on time.

What is your process for tracking vendor vaccination status?

We use Reptrax, which is a database that vendor reps sign up for. It provides all of the credentialing that is needed to satisfy CMS guidelines when surveyors request information. It includes their personal information such as immunization history and proof of training.

Title: Administrator
Facility Name: Union City Surgery Center
City: Union City
State: Tennessee
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

Our facility established a policy and procedures early on, in the development stages of the ASC, requiring all practicing surgeons to dictate and complete postoperative notes immediately following all surgical procedures. This regulation affords a more accurate account of the procedure since it is done so quickly postop. Compliance has not been an issue for our facility. All dictations are printed immediately and signed by the surgeons before they proceed on to the next procedure. Our billing department reviews the postop notes and verifies the correct codes have been assigned to the procedures prior to sending a copy to the physicians' offices. This ensures more accurate medical records and allows for the initiation of the billing process. It has proven to be an efficient practice for the facility and physicians in facilitating reimbursements in a timely manner.

What is your process for tracking vendor vaccination status?

The COVID-19 policy and procedures established at our facility in part covers the CMS-mandated requirement for all members of the healthcare setting to be fully vaccinated. All vendors were notified that to enter our facility and be in the operating rooms during procedures they would be required to provide a copy of their COVID-19 vaccination record, verifying full vaccination status, or apply for either a religious or medical exemption to be reviewed and decided upon by our board of directors. Once a copy of the COVID-19 vaccination record has been obtained verifying compliance, or a waiver has been approved, the vendor is allowed to enter the facility. The front office staff check the COVID-19 checklist to verify that vendors are cleared prior to authorizing entry into the patient area. It has been an effective method.

Title: Administrator
Facility Name: Mann Cataract Surgery Center
City: Houston
State: Texas
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

The governing board or Medical Advisory Committee can make a policy that a surgeon's privileges will be suspended if operative reports are not completed within the 30-day time period. We also have a nurse who is assigned to send reminders to our surgeons multiple times via text or email until the operative reports are completed.

Title: Administrator
Facility Name: Covenant High Plains Surgery Center
City: Lubbock
State: Texas
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

We take a blended approach that is customized to each surgeon. Most dictate immediately after surgery and review and sign electronically within a day or two of the op report being transcribed. A few need gentle reminders, either by email or in person, by our medical records specialist or preop/postop nurses the next time they are here for a case. Some need special attention from time to time.

There are a couple who complete almost all their cases right away, but when they miss something it takes a lot of work to get them to circle back. I text or call them personally as their reports begin to age and remind them with increasing insistence that they won't be able to schedule cases after the 30-day mark. In some cases, I have shown up at their offices with coffee and a box of donuts and a stack of charts to help them along. It is disruptive but these are generally good people who are just disorganized and always running late.

There is one very special case who will flat-out refuse to complete charts right up until the 30-day mark, to the point of finally completing them with patients waiting to go to the OR. We have been unable to persuade them to change; the answer is always "If I have 30 days, I am going to take 30 days." We live with this because this surgeon is not a partner and is a high performer for our center, but we never stop trying to improve the situation.

What is your process for tracking vendor vaccination status?

We use both RepTrax and VendorMate, which cover almost all our vendors. The rest are covered by letters from their employers certifying compliance with CMS COVID-19 vaccination mandates, and from the few remaining solo providers we collect vaccination cards and/or acceptable declination statements.

Title: Administrator/Director of Nursing
Facility Name: North Pines Surgery Center
City: Conroe
State: Texas
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

We offer a variety of options. Surgeons may dictate by phone calling a 1-800 number and dial in their ID number and our location code. Also, the dictation service offers an app where they can use their cell phone. The surgeons also have their specific dictation "templates" that may be used should they see fit. In the OR corridor located centrally across from the operating rooms, there is a work area for the surgeons to dictate and complete the documentation they need for their office. There is a PC at each desk or they may set up their laptop and work from it. It is away from the "main stream," so they are not interrupted, except to do their cases or ID their next patient in preop. They get to do their work and, personally, I would feel great to get all of the work done at this location. They are close enough that the RN circulator can call them in the room once the patient is prepped and draped. It also seems to keep them on schedule being in this location. Once a case is completed, they see their next patient in preop, then sit at this desk to complete the above mentioned work flow process. They are also readily available if the staff or OR RN circulators have any questions.

What is your process for tracking vendor vaccination status?

Per CMS and accreditation entities, we have followed AAAHC's COVID-19 Healthcare Staff Vaccination Process. This includes standards 7.1.A.5 through 7.II.N.3. After viewing a webinar presented by AAAHC, we collected copies of vaccination cards from all physicians, anesthesiologists, staff and vendors. Prior to viewing the webinar, we kept a spreadsheet of everyone's status, which is now four pages of names broken out into ASC staff, anesthesia staff, ASC surgeons and then vendors/company representatives that are assigned to our surgeons doing cases. Copies of the surgeons' and anesthesia providers' cards were placed in their credentialing files.

Those not accepting the vaccination were offered exemption forms to be signed and were also documented on the spreadsheet.

This remains a work in progress as the core group has been documented but every now and then a different vendor may come.

Title: Administrator
Facility Name: The Surgery Center
City: Middleburg Heights
State: Ohio
Length of time your facility has been an ASCA member: Five or more years

How do you encourage your surgeons to complete operative reports on time?

We have a “genius” medical records coordinator and she worked with all of our surgeons to create templates for the majority of their cases. Basically, what she has done is created an operative report for each surgeon and each procedure that they do, which has their routine format, but then she has created blank spaces for them to “fill in the blanks” relative to specifics for that procedure and “multiple choice areas” for them to circle what they want incorporated into that particular operative report.

It used to be a huge issue and she would get so frustrated with the surgeons but since she has done this, basically it is not a problem at all. I must say that we do a lot of ophthalmology, pain management, urology and plastics, so that was helpful in creating the templates. Our GI surgeon and our orthopedic surgeons are “afraid” of her so they always do their reports in a timely manner. The surgeons' office is a huge advocate of getting operative reports completed because third-party payers request operative reports on most claims and no operative report means no payment, both for the professional fee and for the facility fee.

What is your process for tracking vendor vaccination status?

Annually, when we do our employee vaccination updates, we also do our vendor updates, not just on their vaccinations but also on their cell phone numbers, what other local facilities have the same products that we do (so that if we run into an issue we know where we can quickly get something) and obviously, with the COVID-19 PHE, everyone needed to present us with their COVID-19 vaccine cards for our records. Our purchasing coordinator has an index file with each vendor’s information that is kept locked in her office

Title: Director of Operations
Facility Name: WellSpan Health & Surgery Center
City: Hanover
State: Pennsylvania
Length of time your facility has been an ASCA member: Three years

How often do you do a wet procedure room risk assessment for the operating room?

We have operating rooms with standard GFCI's and temperature humidity monitoring remotely and by physical assessment.

What is your policy on the duration of time a physician must be present in your center after the last case of the day is complete?

As long as the anesthesiologist is present until the patient is discharged and in recovery, the surgeon may depart.

Title: Administrator/Director of Nursing
Facility Name: Endoscopy Center of Niagara, LLC
City: Niagara Falls
State: New York
Length of time your facility has been an ASCA member: Five or more years

How often do you do a wet procedure room risk assessment for the operating room?

Annually and as needed.

What is your policy on the duration of time a physician must be present in your center after the last case of the day is complete?

One of our physicians remains present until the last patient leaves our facility. We do not set a duration of time but, typically, it is approximately 30 minutes, which is our standard recovery time.

Title: Executive Director
Facility Name: Surgery Center Cedar Rapids
City: Cedar Rapids
State: Iowa
Length of time your facility has been an ASCA member: Five or more years

What is your policy on the duration of time a physician must be present in your center after the last case of the day is complete?

An anesthesiologist or other physician qualified in resuscitative techniques will be immediately available until all patients have been medically discharged from the center.

Title: Senior Director
Facility Name: Kelsey-Seybold Clinic
City: Houston
State: Texas
Length of time your facility has been an ASCA member: Five or more years

How often do you do a wet procedure room risk assessment for the operating room?

Our ASC performs risk assessments in various areas based on the guidance from our Governing Board and our ASC Quality Committee. Wet procedure room risk assessments are conducted annually for all operating rooms. If new services are added during the year that warrant a wet procedure review, a new risk assessment will be conducted prior to starting the new procedure type or service line.

Title: Administrator
Facility Name: Wausau Surgery Center
City: Wausau
State: Wisconsin
Length of time your facility has been an ASCA member: Five or more years

What incidents/adverse events do you track and how?

We track unexpected complications as well as the measures that will be followed by CMS in the near future: patient burn, patient fall, wrong site, wrong side, wrong patient, wrong procedure, wrong implant and hospital transfer/admission. All are considered risk occurrences and, when identified, are reported via the occurrence reporting process. They are tracked on an ongoing basis and, once reported, are investigated through the occurrence reporting process and reported through the respective committees.

Is your ASC facing staffing shortage and poaching? If yes, how are you handling it?

We have been fortunate to not have staff shortages. We have a very loyal staff and have minimal turnover even with the hospital competition, which lures them with monetary increases. We have and always have had a great culture of teamwork and this has served us well with staff retention through the shortages.

Title: Senior Director of Nursing
Facility Name: Johns Hopkins Surgery Center Series
City: Baltimore
State: Maryland
Length of time your facility has been an ASCA member: Three years

What incidents/adverse events do you track and how?

• PACU length of stay
• Hospitalization
• Admissions
• Patient satisfaction
• Wait time
• Infections
• Turnover time
• On-time start
• Falls

Is your ASC facing staffing shortage and poaching? If yes, how are you handling it?

Yes. I hear stories from my colleagues across the country who have all faced various degrees of staff shortages. The challenge for many ASCs is that your competitors also are facing staff shortages. The hospitals in the community are offering very large sign-on bonuses and increased wages. This is very attractive to employees who can see a change in their economic growth overnight. They can buy the newer car, the bigger house and send Johnny to college; things that they couldn't afford just last week.

The best approach in dealing with the challenge of staffing is to be proactive, communicate with staff and make the work conditions as stress free as possible. It is easier said than done, but what the pandemic has taught us is that ASCs need to be flexible and compassionate, and understand that staff want their economic needs and desires met by their employer. They also want to be part of an organization that is a great place to work.

Title: Chief Executive Officer
Facility Name: Harmony Surgery Center, LLC
City: Fort Collins
State: Colorado
Length of time your facility has been an ASCA member: Five or more years

What incidents/adverse events do you track and how?

We track every incident/occurrence/event that is not consistent with our routine operation in delivery of care and treatment to patients or the functioning of the center. So, anything that deviates from our "norm" or standard practice, initiates an occurrence report.

Our occurrence report is an organized data collection tool which provides the user with the ability to capture prompt and accurate details of an occurrence or potential occurrence. The report provides a method for identification of an occurrence or a deviation from standard practice and a means to implement an investigation of the cause or a tracking mechanism. Examples of what we track include, but are not limited to, injury, patient transfers, fall, blood product transfusions, transfusion reaction, cancellations after admission, procedure complications, medication errors, drug reaction, patient complaint, prolonged nausea/vomiting, bleeding, re-operation, cardio-respiratory arrest, new neurological deficit, organ injury, safety concern, adverse anesthetic event, any undesirable circumstance that deviates from the expected outcome, environmental disaster and equipment malfunctions.

All our quality data flows up to our Medical Quality Assurance Committee and then the governing body for review and oversight. By having a robust quality assurance process and program, we are able to identify and resolve issues quickly before they become a problem to ensure we continue operating at an optimal level, providing safe and high-quality care to our patients and a safe environment for our team members.

Is your ASC facing staffing shortage and poaching? If yes, how are you handling it?

Yes, our facility has been facing staffing shortages like most everyone else. We not only have less applicants to choose from when we post a position, but have also experienced positions being vacant for longer periods of time. It has been harder to compete with the local hospitals, especially for RNs and surgical techs, as they continue to increase their wage ranges and pay scales to attract and fill their open positions.

In addition to open positions, we continue to have staff out due to COVID-19 exposures. With case volume being higher and our schedules packed, these staffing shortages take a toll on our team.

To address this challenge, we have had to increase our wages multiple times over the last year to stay in the same ball park and compete with other healthcare entities. To support our team and help keep our work environment positive during these challenging times, we try to provide snacks, meals and coffee cart days to increase morale. Another avenue we are exploring is reaching out to the local colleges to attract new RN and surgical tech graduates.

Title: Director of Organizational Development
Facility Name: Surgical Care Affiliates
City: Deerfield
State: Illinois
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

The fundamental underpinnings to our evaluations focus on what the teammate has accomplished and how they accomplished them.

The "what" is determined by the teammate’s performance and progress on their yearly goals. Depending on the teammate’s position and responsibilities, those goals might be specific to their job or aligned to the performance of their team, function or facility, broader organizational strategies or our enterprise “vitals,” which include our quality index, teammate experience, physician satisfaction and same site earnings growth.

The "how" is determined by the behaviors and competencies the teammate demonstrated throughout the year. Every teammate is evaluated on how they demonstrate our seven organizational values: clinical quality, integrity, service excellence, teamwork, accountability, continuous improvement and inclusion. Some teammates also are evaluated against technical or behavioral competencies—we call them success practices and behaviors—that are specific to their position.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

Yes. Our teams drafted and implemented an extensive set of safety policies related to COVID-19 that include infection control components where applicable. This includes patient and visitor screening, social distancing, the use of PPE, healthcare worker exposure, staffing shortage mitigation, laboratory testing for the healthcare workers, preoperative testing for patients and other critical infection control topics. In addition, we have instituted a robust respiratory protection program and have updated our annual infection control risk assessment to address COVID-19 pandemic issues and responses.

This has helped our ASCs respond to the pandemic by providing standardized and updated policies and resources to protect the health and welfare of all patients, teammates and physician partners in this ever-changing environment.

Title: Clinical Director of Quality and Patient Safety
Facility Name: Surgical Care Affiliates
City: Birmingham
State: Alabama
Length of time your facility has been an ASCA member: Five or more years

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

Yes. Our teams drafted and implemented an extensive set of safety policies related to COVID-19 that include infection control components where applicable. This includes patient and visitor screening, social distancing, the use of PPE, healthcare worker exposure, staffing shortage mitigation, laboratory testing for the healthcare workers, preoperative testing for patients and other critical infection control topics. In addition, we have instituted a robust respiratory protection program and have updated our annual infection control risk assessment to address COVID-19 pandemic issues and responses.

This has helped our ASCs respond to the pandemic by providing standardized and updated policies and resources to protect the health and welfare of all patients, teammates and physician partners in this ever-changing environment.

Title: OR Manager
Facility Name: OAM Surgery Center at MidTowne
City: Grand Rapids
State: Michigan
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

We perform annual self-evaluations for employee reviews. Different criteria are used to ultimately determine an employee's review score. Each section is rated with a score of one through four. One being unsatisfactory, employee must demonstrate improved work performance. Two being development needed, performance standards are not fully achieved: performance improvement is expected. Three is successful, work is fully satisfactory: employee consistently meets and occasionally may exceed performance standards. This represents the expected level of performance as established by the employee's supervisor. Four is above expectations, work is fully satisfactory and often exceeds performance standards.

There are six review criteria an employee must complete. The first self-review criteria is job performance and understanding. The employee considers the performance, quality and understanding of the their work in terms of volume and accomplishments. Interpersonal skills and teamwork are reviewed next. The employees reflect on their behavior and how it fosters a collaborative working relationship in a diverse environment. We review an employee’s adherence to and knowledge of company policies. The next area of review is customer service and if an employee goes above and beyond to make each interaction with patients, coworkers, physicians and vendors positive. Finally, an employee's approach to work is evaluated. This section is an overall review of their goals, self-growth and promoting OAMS initiatives. After an employee does a self-evaluation, it is reviewed by leadership staff to make additional comments and notes. It is under leadership discretion to raise an employee to a higher score when they see fit.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

We have chosen to draft a new policy specific for COVID-19, rather than tack an addendum onto our existing policies. Our COVID-19 policy is quite robust and includes information regarding social distancing guidelines, screening requirements (for employees, ancillary staff and patients) and what to do if they do not pass screening, how to mitigate staff shortages and information regarding PPE, linen, cleaning/disinfecting, postoperative monitoring and tracking.

We have gone so far as to institute a separate policy specific for COVID-19 testing of our patients prior to their surgery date as well.

Policies are a great way to distribute information to our staff and serve as a good resource for them in times of need.

Title: Director
Facility Name: The Surgery Center of Charleston
City: Charleston
State: South Carolina
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

Performance reviews are a great way to communicate with your employees. We have annual performance reviews and goals to evaluate success over the prior year. The employee first self-reviews, then their manager reviews. The criteria includes job knowledge, quality of work, productivity and efficiency, attendance, initiative, communication, adherence to policy, interpersonal relationships and goals.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

Yes, we developed and implemented policies and procedures for COVID-19. The pandemic has been fluid and evolving since it started. We created a COVID-19 committee, including our medical director, governing board officers, medical executive and infection control officer. This committee was able to make decisions quickly based on the most recent recommendations from the state, CDC and our community standards to protect our staff, physicians, patients and patients' caregivers. We also performed a COVID-19 risk assessment and adopted OSHA’s respiratory protection program. Our policies and procedures are communicated to our patients prior to surgery, instilling confidence in our center, and they sign a COVID-19 consent the day of surgery. All COVID-19 updates and guidelines continue to be communicated to staff and physicians to provide reassurance and knowledge. By instituting preventative measures, policies and procedures and staying up to date on the latest guidelines, we are able to provide a safe and comfortable environment.

Title: Regional Administrator
Facility Name: Reagan Street Surgery Center
City: Los Alamitos
State: California
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

We base our evaluation criteria on the position description for each employee. In addition to job-specific metrics and the usual time and attendance measures, we also review employee participation in the center's patient experience program and support of our mission statement.

Another key feature of our evaluation/feedback process is a scheduled midyear check-in. Having this meeting provides an opportunity to give specific detailed feedback on employee performance and discuss improvement opportunities. It also allows the managers an opportunity to identify any additional training, education or resource requirements to support our employees.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

Yes. Our center adopted a specific COVID-19 infection control policy to identify specific responses our center would take to keep our patients and employees safe during uncertain times. This policy incorporated the best practice guidance provided by ASCA as well as state and national public health entities. Having a center-specific policy also helped our employees feel more confident in our response to the pandemic. We communicate our policy protocols to our patients in an effort to provide them a sense of safety and confidence in our organization.

Title: Administrator
Facility Name: Boston Out-Patient Surgical Suites
City: Waltham
State: Massachusetts
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

Job knowledge, communication and interpersonal skills, customer service, initiative, and team skills. We rate them as: exceeds expectations, meets expectations, needs improvement or N/A. We have a comment section where we talk about the details of these items and their rating, and then we have an action plan section where we ensure we put goals for the upcoming year, strategies for improvement, etc. The employee's merit increase would be based on the cumulative scores received. It's very tough to not give an employee a full increase this day and age, with staffing challenges, but it happens. We ensure we take the opportunity to document anything we need to.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

Yes, early on, in the beginning of the pandemic, we established a myriad of infection control policies. This covered everything from cleaning to exposure control. The foresight the clinical leads at our management company had to establish these not only put us on the forefront of communication with our staff, surgeons and patients, but it allowed us to maintain compliance during this difficult time. These policies are dynamic and constantly evolving to the situations around us.

Title: Executive Director
Facility Name: Hunterdon Center for Surgery
City: Flemington
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

We have a job description that the evaluation mirrors. There are criteria that are graded with a score of 1­–3, with 3 being the highest.

There are specifics for each job, with the addition of common areas of communication, cooperation and attendance.

Merit increases are tied to the scores.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

We have made specific policies pertaining to screening, PPE and educational competencies, i.e., for cleaning, etc.

We have not made a specific change to our infection prevention policy, as the policy was fairly robust with regard to infectious diseases and did address other infectious diseases, like SARS and MRSA, that would be treated in the manner COVID-19 would be.

The basics of the policy covered the general guidelines, but then we specifically branched out to cover PPE, respiratory, cleaning, etc., but more in the way of competencies to ensure that the policy was understood and being followed appropriately.

Title: Vice President of Clinical Operations
Facility Name: Surgical Management Professionals
City: Sioux Falls
State: South Dakota
Length of time your facility has been an ASCA member: Five or more years

What criteria do you use for employee evaluations? How do you rate the items or areas you evaluate?

We have a mixture of employee evaluation types depending on facility needs, structure and hospital partnerships. Staff appreciate understanding and knowing expectations as well as methodology related to salary increases. Merit-based salary increases work if the managers are consistent in methodology related to scoring techniques. Base increases, while consistent and easy, can also lead staff to believe that they will "get the raise" regardless of productive behavior.

Transparency related to salary as well as job expectations helps facility culture and eliminates surprises during the employee evaluation. No employee should ever be taken completely "off-guard" related to a poor evaluation. As leaders and managers, our role is to consistently try and promote open communication and dialogue related to expectations.

Have you created an infection control policy addendum specific to COVID-19? If not, why not? If so, how has it helped your ASC?

The addendum for infection control policies was created for more generalized pandemic responses. COVID-19 will not go away and we will continue to be faced with variants. Making sure that the policies reflect following CDC guidelines allows policies to be updated and changed as the CDC changes its guidelines and alleviates the need to constantly change the unique policy.

Writing the policy to reflect ongoing CDC standards allows governing boards to follow CDC regulations versus the local board to authorize appropriateness of the unique policy. Each ASC has been encouraged to be involved in its state and local region outcomes and work with its joint-venture hospital related to consistent methodology for treatment, testing, employment, etc.

Title: Administrator
Facility Name: Fleming Island Surgery Center
City: Fleming Island
State: Florida
Length of time your facility has been an ASCA member: Five or more years

How do you perform disaster drills during work time and make them pertinent?

Not interrupting the flow of cases and ensuring all staff are involved is tricky. I have found having a written scenario, blocks for the response and areas to improve is helpful. For example, our last disaster drill scenario was a generator fire. The setting was: the generator sits on 750 gallons of diesel fuel; the fire marshall has ordered immediate evacuation of the center; what is your responsibility and what do you need to do?

The areas we included in the drill were the business office, preop, OR, endo and PACU. The physicians performing surgery and procedures were included in the discussion leading up to the drill. Because we had to close the building and get the patients out quickly, we asked the anesthesia department what they would need to transport the patients safely out of the building. American Health Care Association inspection followed soon after, and the inspector was impressed with our write-up.

How long before their procedure do you ask patients to arrive? How do you reduce wait times?

Our patients come in one to one-and-a-half hours prior to surgery. Patient wait times are pulled by physician any time there is an issue and randomly through out the year to adjust arrival times if needed. We found one practitioner was not completing cases as quickly as the block schedule had them booked. We adjusted the block accordingly.

Title: Director of Clinical Operations
Facility Name: Johns Hopkins Surgery Center Series
City: Baltimore
State: Maryland
Length of time your facility has been an ASCA member: One year

How do you perform disaster drills during work time and make them pertinent?

We schedule quarterly drills at different times of the day so we can ensure all staff receive training. Also, because a disaster occurring as everyone is just arriving to work could be quite different from one that might occur in the middle of the day or after most of the staff have gone for the day. In addition, we create different scenarios so that staff can walk through the appropriate responses for each case scenario. We make sure that staff act as active participants in the drills versus simply acting as observers so that everyone is familiar with the various roles they could play during a disaster.

How long before their procedure do you ask patients to arrive? How do you reduce wait times?

We ask our patients who are receiving regional blocks to arrive one-and-a-half hours before their scheduled procedure. All others arrive one hour before.

We reduce wait times by accurately scheduling cases. This means we look at our surgeon average procedure times based on the type of procedure. We also ensure that we add in time for room preparation and turnover. This helps us to avoid having patients arrive too early or too late. If there are delays during the day, when possible, we try to contact patients to arrive at a later time.

Title: Administrator
Facility Name: Summit Surgical Center
City: Voorhees
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

How do you perform disaster drills during work time and make them pertinent?

Drills are scheduled in advance. We have employees designated as observers who will complete a written evaluation during the drill and the results are reviewed with the safety officer. The safety officer makes recommendations and submits suggested changes to the disaster plan to the Clinical Operations Committee and the Board for review and approval.

How long before their procedure do you ask patients to arrive? How do you reduce wait times?

One hour. We use patient texting software to keep patients informed of delays when possible. We also use tracker boards to facilitate communications between the OR desk and preop so delays can be communicated.

Title: Administrator
Facility Name: The Endo Center at Voorhees
City: Voorhees
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

How do you handle unusually long days? Allow overtime, reschedule cases, have a call team, something else?

We have our staff scheduled as early staff and late staff. Should we run past our late staff time, which is 6:00 pm, we would allow overtime if need be. We do not make it a practice to reschedule patients as they have prepped and taken time off from work. If a physician does run late, our staff will call patients to come in later, so that they can stay comfortable at home rather than having to sit at the center and wait.

If you use an EHR/EMR system, what has been your experience?

We use Provation EMR and it has worked well for us. Our scheduling system, HST Pathways, interfaces with Provation, which is a great time saver. I find it to be user-friendly.

Title: Administrator
Facility Name: Laurel Surgery & Endoscopy Center LLC
City: Laurel
State: Mississippi
Length of time your facility has been an ASCA member: Five or more years

How do you handle unusually long days? Allow overtime, reschedule cases, have a call team, something else?

Staggered staff scheduling, using PRN staff as needed, allowing overtime if required.

If you use an EHR/EMR system, what has been your experience?

Improved perioperative communication, reduced chart prep time for business office staff, cost-effective after initial implementation.

Title: Nurse Administrator
Facility Name: Evergreen Endoscopy Center LLC
City: South Windsor
State: Connecticut
Length of time your facility has been an ASCA member: Five or more years

How do you handle unusually long days? Allow overtime, reschedule cases, have a call team, something else?

We try to work together as a team, provide extra staffing and approve overtime. When the staff picks up additional shifts on the weekend, a bonus is provided.

If you use an EHR/EMR system, what has been your experience?

It is challenging in the beginning, especially learning the new system and transitioning from paper to computers. Not everyone is efficient with computers and is technology savvy. Then there are the occasional IT issues that clinical staff cannot fix, so it can be really frustrating. EMR does increase the clinical workflow once you get accustomed to it.

Title: Nurse Manager
Facility Name: Johns Hopkins Surgical Center Series - Lutherville and Bel Air
City: Baltimore
State: Maryland
Length of time your facility has been an ASCA member: Two years

What are your three best tips for getting through an inspection or survey?

1. Prepare and do audits, mock drills and staff education. Have paperwork you know the surveyors will request to see ready and available. Have a comfortable, private area for surveyors and the team to meet.
2. Activate and utilize all available resources to assist. Remind team members—including administrators, HR personnel, nursing leadership, facilities/engineering staff and pharmacists—early that "we are all in this together," and that there is an expectation that when the surveyors arrive they will make themselves available to participate. This also reinforces to the surveyors that this is a team effort and we have staff with expertise in all areas.
3. Humor and Red Bull for breakfast.

How are you validating your patients are indeed COVID vaccinated? Are you asking for proof or taking their word for it?

We do not ask/require vaccination status.

Title: Quality/Regulatory Coordinator, IC Nurse
Facility Name: Surgery Center of Southern Oregon
City: Medford
State: Oregon
Length of time your facility has been an ASCA member: Five or more years

What are your three best tips for getting through an inspection or survey?

1. Conduct mock surveys. I know they are very revealing but difficult to find time to perform. It is best to have someone who is knowledgeable of standards in the area, but not the person who works that area, to conduct the mock survey. I would rather have a fresh set of eyes scrutinize and ask questions rather than assume that things are being done correctly.
2. Have leadership stay with the surveyors as much as possible, don't leave surveyors to wander or find their own way.
3. Speak to what you know, don't offer more than what is asked for.

How are you validating your patients are indeed COVID vaccinated? Are you asking for proof or taking their word for it?

We ask patients if they have been vaccinated and if they are more than 14 days past the last vaccination. We do not require proof.

We do require proof from students and new hires.

Title: Director of Nursing
Facility Name: Lowery A. Woodall Outpatient Surgery Center
City: Hattiesburg
State: Mississippi
Length of time your facility has been an ASCA member: Five or more years

What are your three best tips for getting through an inspection or survey?

1. Be prepared by following your state standards and national conditions for coverage daily.
2. Prep the staff by reminding them that our daily clinical practice is based on our facility policies, which, in turn, are based on national recommendations and guidelines.
3. Have an open mind for suggestions/recommendations from surveyors.

How are you validating your patients are indeed COVID vaccinated? Are you asking for proof or taking their word for it?

We have the patients bring their vaccination card with them.

Title: Chief Officer of Ambulatory Surgery Centers
Facility Name: Renaissance Surgery Center
City: Bristol
State: Tennessee
Length of time your facility has been an ASCA member: Two years

How do you keep staff morale up?

We try to create and maintain a family environment and keep everyone involved in the processes, and any changes to policies, procedures, etc. I have found that if employees feel that they have a voice and aid in making decisions that affect their daily routine, they are more apt to implement those changes and champion the project. We plan a lot of potluck meals, and keep lines of communication open. People who enjoy coming to work take better care of each other and their patients. We plan a lot of events to celebrate all major holidays and others like Mardi Gras Week, Nurses Week, Tech week, etc., to keep things fun. It gives the staff time to bond and all managers are involved as well.

What are your best tips for running an effective and efficient governing body meeting?

I always send out the agenda and full packet at least a week or two in advance. This gives the members an opportunity to review and ask any questions, so that they can be discussed by the full committee at the meeting. They feel more prepared and it makes things run smoothly and efficiently. We also try to stick to the agenda. I do send out a request for any items to be added to the agenda in advance, so that we are prepared for those items and can move through them quickly.

Title: Administrator
Facility Name: SOG Surgery Center
City: Tupelo
State: Mississippi
Length of time your facility has been an ASCA member: One year

How do you keep staff morale up?

Keeping morale up is an ongoing effort. Transparency is important to the team, so I make an effort to communicate in multiple ways. I hold quarterly staff meetings and provide a newsletter-style communication between meetings. We implemented an employee-of-the-month program and we have a kudos board in our break room for peer recognition. We conduct annual staff surveys and recognition always ranks high in importance among motivating factors. Our governing body is generous and allowed me to implement a metric-based quarterly incentive plan as well.

What are your best tips for running an effective and efficient governing body meeting?

Each governing body is unique, so tailoring the meeting to the audience is key. My governing body is relaxed and, as an independent ASC, they are very financially focused. Putting the things first on the agenda that are required but may not be the favorite topics helps to ensure that attention is not lost when it is time to discuss those things. Providing information in advance helps reduce the meeting time and allows the members to be prepared.

Title: PACU Nurse Manager
Facility Name: Centerpoint Ambulatory Surgery Center
City: Independence
State: Missouri
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

Provide meals on busy days.

Send thank you cards to staff for exceptional work.

Provide assistance when help is requested.

Title: Administrator
Facility Name: Endoscopy Center of Monmouth County
City: Freehold
State: New Jersey
Length of time your facility has been an ASCA member: Three years

How do you keep staff morale up?

I make every attempt to eat with my staff in their space, and it then becomes a chat and chew. This allows me to keep my finger on the pulse, on what the hot topic of disenchantment is at the center without putting staff on the spot during our huddles. I have appreciation Monday on my phone where I give an individual a token of appreciation along with a card.

I have an open door policy and my staff knows this and they are very comfortable sharing their concerns and comments with me. Sometimes I just listen and other times I make a point of addressing the concern immediately.

What are your best tips for running an effective and efficient governing body meeting?

I start on time. I speak with the key players about any issue or item on the agenda that may require a vote, so that the board may ask questions prior to the meeting, which also allows me to dig deeper and provide more details. This could also lead me to not put an item on the agenda because I need more information. Secondly, I ask for the board's input for agenda items. I come prepared to answer questions regarding the items I put on the agenda. My format is clear, I send out reminders to the board members a week in advance. I type out an agenda with all my answers and notes so that I don't skip any pertinent items.

Title: Clinical Director
Facility Name: Indiana University Health Bloomington Endoscopy Center
City: Bloomington
State: Indiana
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

Our leadership team uses a multifaceted approach to maintain team member engagement and staff morale. The first is that we heavily rely on team member input for process improvement ideas and solution creation. We find that as the clinical experts, the decisions made will affect the frontline team members the most. Therefore, it is crucial to involve them in the decision-making process. Next, we utilize a looping system where our team members take a patient in the pre-procedural phase and follow them through the procedure as the circulator. This helps with preventing burnout because it gives them role variety and allows them to build relationships with the patient. Lastly, we have a thorough rounding and recognition program. We round daily on team members to see what is working well and what can be improved. We ask for team members to be recognized at the daily huddle and follow through with team recognition events for wins such as our 91.2 percent patient experience score YTD or for National Nurses Week.

What are your best tips for running an effective and efficient governing body meeting?

This has been a learning process for me for sure. I have had to gauge the key items that our governing body wants to know. Previously, we would report out on everything and the meeting turned into a very ineffective information dump. Now, we send the entire report and packet out in advance for the governing body's review. During the meeting, however, we utilize a summarized agenda and executive summary to create meaningful conversation on large items. All the information is still presented to them but we focus our efforts on the important decision-making points.

Title: Administrator
Facility Name: Cascadia Surgical
City: Mount Vernon
State: Washington
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

I’m blessed to have a wonderful team of nurses, medical assistants and technicians who work together well and care about each other! We all help keep staff morale up by mutual encouragement. Our governing board is generous with cost-of-living raises, Christmas end-of-year bonuses and staff appreciation gifts. For National Nurses Week this year, for example, we gave eight hours of PTO to our FT nurses. Over the years, we have done various group fitness contests with mileage goals, employee satisfaction surveys (one must be prepared for honesty), a weekly staff e-letter called Within Normal Limits featuring staff, celebrating successes, etc., and Atta Girl Pop Up Awards (with $100 bills attached). All of these have helped keep the work environment fun and positive.

What are your best tips for running an effective and efficient governing body meeting?

My best tip is to prepare the minutes ahead of time—in draft form that can be updated wth board direction and action—and email to members prior to a meeting. Alternatively, administrator reports can be emailed ahead of time so subcommittee activities can be reviewed prior to meeting together. This allows board members to be prepared for the discussions and provides equal opportunity for participation whether the doctor is a faster or slower "processor."

We also use a tracking spreadsheet with all governing board oversight responsibilities, such as medication formulary, employee competencies and exempt tissue policy, with the last date the board reviewed those items and the next due date.

Title: Administrator
Facility Name: Summit Surgical Center
City: Voorhees
State: New Jersey
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

We encourage the staff to stay patient-focused. We listen to their concerns, give recognition to their hard work and try to be transparent and honest when giving feedback. I have open forum meetings with staff monthly to get their feedback and hear concerns. We encourage education opportunities and growth.

What are your best tips for running an effective and efficient governing body meeting?

Distribute the board agenda and packet prior to the meeting so board members have time to review. Set the expectation for the length of the meeting and stay on schedule. If an issue requires more time than allowed, try to bring the discussion to a conclusion and get a consensus for the next step, i.e., set up a work group to make recommendations to present at the next meeting or agree to voting by email if it is time sensitive. A timed agenda also helps.

Title: Administrator
Facility Name: The Surgery Center at TGH Brandon Healthplex
City: Tampa
State: Florida
Length of time your facility has been an ASCA member: Two years

How do you keep staff morale up?

Listening and taking action are the key to driving and maintaining staff morale. Frequent staff meetings and one-on-ones with each member of the team allow opportunities to make suggestions for improvement publicly or privately. We placed a white board in our break room and encourage the team members to write their wishes (opportunities for improvement, additional equipment, updates they would like to see in the EHR, etc.).

When wishes are added, the leadership team evaluates and places in one of three categories: 1) Implement Quickly 2) Planning Mode or 3) Future Project. At each staff meeting, the leadership team spends just a few minutes reviewing items on the wish list and steps that are being taken. Of course, there are occasional items that are simply not feasible and these are addressed, as well, allowing discussion with the team regarding why they are not feasible or other options that might provide the desired result. I have found that transparency and honesty is the best solution to answering questions.

In addition to staff feedback, we also seek input from our surgeons and encourage them to provide positive feedback and on-the-spot recognition fostering a “One Team” approach to patient care. It is not uncommon to see surgeons walking through the ASC, following their cases and thanking the staff for a great day.

What are your best tips for running an effective and efficient governing body meeting?

I utilize a consent agenda for the routine quarterly informational items, such as volume, broken down by specific surgeons and payor mix, infection control data, hand washing surveillance, new product or formulary requests along with cost analysis, information on drills, in-services and staff education, routine life safety items, etc. I send the consent agenda along with any supporting documents to the governing board approximately a week before the meeting. The board members are asked to review the consent agenda items and supporting documents prior to the meeting and come prepared to discuss their questions or concerns. This allows for a quicker review and approval process during the meeting and allows time to address new items, credentialing appointments/reappointments and facility financials.

Title: Regional Administrator
Facility Name: Reagan Street Surgery Center
City: Los Alamitos
State: California
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

At our center we try to focus on making each day as enjoyable as possible. We look for things to celebrate with our staff—whether business or personal—and we always have lots of food in the lounge.

One new activity we are doing this year is to share two unique things about ourselves with our group, and then we try to mention some of these unique facts with our patients during hand-offs and discharge. We do this with the goal of "managing up" our care team, instilling patient confidence in our teamwork and to connect our team with each other in a more meaningful way. Lots of fun, laughter and interesting stories.

What are your best tips for running an effective and efficient governing body meeting?

Develop a consent agenda to address and approve all quarterly reporting at the beginning of each meeting. That will free up time to focus on key issues of the day and for review of the financials.

Title: Senior Operations Consultant
Facility Name: Avanza Healthcare Strategies
City: Florence
State: South Carolina
Length of time your facility has been an ASCA member: Five or more years

How do you keep staff morale up?

Staff morale starts with great leadership. In ASCs, this begins with the governing board selecting an administrator who creates an environment of teamwork, respect and efficiency. When call-ins are high and the staff does not have the opportunity to enjoy downtime during a quick break or time off for vacations, morale will tank. Encouraging staff and aligning on common goals will keep them focused and pushing through when times are uncertain or busy. Pens, reusable cups and T-shirts are great gifts but if a leader waits to show their team that they are valued and appreciated with gifts, chances are morale is already an issue. Be proactive and engage and your staff will follow.

What are your best tips for running an effective and efficient governing body meeting?

Have an agenda and stick to it. Time the sections of the material and allow for questions and feedback from the board. Coordinate with the president and medical director to ensure everyone is on the same page going into the meeting. Try to make the meetings something to look forward to and not a dreaded occurrence.

Title: Chief Officer of Ambulatory Surgery Centers
Facility Name: Renaissance Surgery Center
City: Bristol
State: Tennessee
How long has your facility been an ASCA member? Two years

What are your top three supply chain management tips?

Adopt a good supply management software to track purchase orders, payment trends and ensure compliance with your GPO contracts.

Involve the staff in the purchasing process to ensure they have ownership and accountability of the process. We assign people to different areas in which they are responsible for ordering. This helps ensure they have what they need and they know the pricing on the items to aid in cost management. The orders are then given to the materials manager for final execution.

Select a good GPO that works with your service line, as well as a distributor to keep cost low and develop relationships that are crucial to ensure that your product is available and readily accessible.

What kinds of procedures do PAs assist with on your Medicare patients?

Total joints and various other large orthopedic cases, as well as some larger gynecological cases.

Title: Director Perioperative Services
Facility Name: LVHN Children's Surgery Center
City: Allentown
State: Pennsylvania
How long has your facility been an ASCA member? One year

What are your top three supply chain management tips?

1. It is essential to really involve the supply chain person and/or department to keep daily communication flowing.
2. It is very important to work with supply chain to obtain the best contracting possible.
3. I try to make sure all expenses go though supply chain to keep accurate case costing.

What kinds of procedures do PAs assist with on your Medicare patients?

Our PAs assist the surgeons so the billing is done through the surgeon. They are credentialed as allied health providers.

Title: Director of Nursingbr />Facility Name: Hudson Valley Ambulatory Surgery Center
City: Middletown
State: New York
How long has your facility been an ASCA member? Three years

Tell us about a time you used benchmarking data to identify a QAPI project in your ASC. What did you study and how did the project help you improve your ASC?

We used patient satisfaction survey results and compared with the national average to identify an emerging problem with family member communication during a patient’s surgical intervention. Because of the COVID-19 pandemic, families and visitors are not permitted in the surgery center. Although we are complying with state regulations, we were neglecting the fact that the families of our patients needed more communication than just a discharge phone call. We have utilized this benchmark data to flag a deficit in patient-family-centered care and have made improvements to our family communication policies and are seeing an increase in patient satisfaction responses on our surveys.

What is your employee vaccination policy?

We are keeping it voluntary.

Title: Lead CRNA
Facility Name: Southwestern Ambulatory Surgery Center
City: Pittsburgh
State: Pennsylvania
How long has your facility been an ASCA member? Five or more years

Tell us about a time you used benchmarking data to identify a QAPI project in your ASC. What did you study and how did the project help you improve your ASC?

We have used and participated in the ASCA benchmarking [survey] program for many years as well as various ones through our state organization. We were able to identify several different QAPI projects throughout the many years our facility has been open—35 years. Some of the ones we have done included a variety of infection control projects, review and reduction of case cancellations, improvement and revamping of our preop assessment process and the use of preop acetaminophen to reduce opioid use, to name a few.

What is your employee vaccination policy?

We offer the COVID-19 vaccine to all employees, medical staff and anesthesia providers. It is voluntary but encouraged for those who are interested. We have been able to get our staff scheduled at local hospitals and pharmacies. Many have had both doses of the Pfizer-BioNTech or Moderna vaccines.

Title: Executive Director
Facility Name: Hunterdon Center for Surgery
City: Flemington
State: New Jersey
How long has your facility been an ASCA member? Five or more years

Tell us about a time you used benchmarking data to identify a QAPI project in your ASC. What did you study and how did the project help you improve your ASC?

We utilized the ASCA benchmarking [survey] for normothermia and performed a QAPI study on our own patients to determine if we were indeed meeting the requirement to maintain normothermia within 15 minutes of arrival to the PACU, as defined by the ASC Quality Collaboration and the ASCA benchmarking.

The results of the study led us to purchase new thermometers, educate staff on using bair hugger, warm blankets and fluids.

We saw improvement in our practice following these interventions.

What is your employee vaccination policy?

We strongly encourage all employees to get vaccinated.

Title: Administrator
Facility Name: Mid-Atlantic Surgery Pavilion
City: Aberdeen
State: Maryland
How long has your facility been an ASCA member? Four years

Tell us about a time you used benchmarking data to identify a QAPI project in your ASC. What did you study and how did the project help you improve your ASC?

We benchmarked ourselves using our accrediting organizations' benchmarking data for cataract procedures. There were areas where we excelled and areas where we were below the median. We looked at the areas below the median and decided to work on those.

One area we could improve was discharge times. Our discharges took approximately 25 minutes and the benchmarking data showed the average discharge times were approximately 17 minutes. We took this information and turned it into a QAPI project.

We discussed ways we could make our discharges more efficient. We decided on three variables to implement that would help to decrease our average discharge timing. We moved the placement of our discharge area closer to the door, we streamlined our discharge teaching process, and we called the patient's ride to let them know to bring their car to the front of the building when the patient was brought into PACU. We performed these changes over a four-week period and then began measuring our times. From those implemented changes, we safely decreased our average discharge timing down to 18 minutes. This allowed discharge staff more time to help in the preop area and with cleaning the area between patients.

What is your employee vaccination policy?

At this time, we do not have a mandatory vaccine policy. Over the years, most staff have become compliant with the flu vaccine. The COVID-19 vaccine is not mandatory yet but we will follow CDC recommendations as they become more readily available.

Title: Facility Administrator
Facility Name: Beaumont Heart and Vascular Surgery Center
City: Beaumont
State: Texas
How long has your facility been an ASCA member? Two years

What measures do you use in your infection prevention and control assessment tool?

1. Hand hygiene, both proper indication and technique
2. Proper sterile technique
3. Medication safety/aseptic technique
4. Proper use of PPE
5. Terminal cleaning
6. Proper POC cleaning
7. BBP exposure
8. Proper disposal of sharps
9. Linen handling

What is the highest BMI you allow and in what age group?

Our maximum weight for our procedure table is 205 kgs.

Title: Director of Nursing/Administrator
Facility Name: Tallgrass Surgical Center
City: Topeka
State: Kansas
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

1. Hand hygiene
2. Sterilization
3. High-level disinfection
4. Safe injection practices
5. COVID-19
6. Anesthesia ASA scoring, increasing prevalence of obesity

What is the highest BMI you allow and in what age group?

All patients with a BMI greater than 50 are reviewed by our anesthesiologists.

Title: Clinical Manager
Facility Name: Carolina Center for Specialty Surgery
City: Charlotte
State: North Carolina
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

1. SSI
2. Safe injection practices
3. Hand hygiene
4. Cleaning and disinfecting
5. Sterilization practices

What is the highest BMI you allow and in what age group?

We do not have a specific cutoff. If a patient's BMI is over 40, the case goes to anesthesia for review and clearance.

Title: President and Chief Executive Officer
Facility Name: Mississippi Valley Surgery Center & Endoscopy Center
City: Davenport
State: Iowa
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

We use the same measures as the Centers for Medicare & Medicaid Services, i.e., safe injection practices, immediate use steam sterilization and blood-borne pathogen controls.

What is the highest BMI you allow and in what age group?

We allow up to a BMI of 50.

Title: Director of Clinical Services
Facility Name: Ambulatory Healthcare Strategies
City: Rochester
State: New York
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

Our infection prevention and control assessment tool has grown exponentially over the last few years, especially in 2020. The audit tool is made up of a multitude of tasks to be observed and assessed for compliance. Originally, we focused on areas such as hand hygiene, decontamination and sterilization practices—including HLD processes—and environmental surveillance measures. Most practices were to assist in the prevention of surgical site infections. Fast forward to COVID-19, and we now utilize a microscope based on potential airborne exposure. We are hyper-vigilant in regards to hand hygiene practices, utilization of and access to ABHR, as well as the wearing of gloves. Instrument processing begins at the point of use, involves transport mechanisms, along with the handling and final storage of items. Environmental hygiene includes clinical, nonclinical and business office areas of the center as well as an emphasis on climate control functions. Product selection and utilization for cleaning and decontamination are also monitored for compliance. Staff attire and PPE utilization has resurfaced as an area requiring education and assessment. I would be remiss to not include safe medication practices ranging from storage, preparation and administration. It is likely that I have omitted other areas of focus as the tool is a continuous work in progress, I like to say it is written in pencil.

Title: Clinical Education Director
Facility Name: Surgical Care Affiliates
City: Birmingham
State: Alabama
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

We conduct monthly infection control rounds to assess that effective infection control and prevention best practice measures are in place. These rounds include hand hygiene compliance, PPE compliance, COVID-19 mitigation protocols, high-level disinfection and sterilization protocols, policies, environmental cleaning and disinfection, safe medication handling and injection practices, and patient infection surveillance and reporting procedures throughout the organization. These reports are forwarded to the Governing Body for review, recommendations, actions and approvals.

We also utilize the CMS Infection Control Surveyor Worksheet, Exhibit 351, for IC monitoring in the ASC setting. This is another excellent tool to measure:

1. Hand hygiene compliance: before and after direct patient care activities; after removing gloves; before and after performing invasive procedures; wearing gloves for procedures that might involved contact with body fluids or blood; wearing gloves when handling potentially contaminated patient equipment; removing gloves before moving to the next task/patient care activity; and assessing personnel providing direct patient care to make sure they do not wear artificial fingernails and/or extenders when having direct contact with patients.
2. Observation of safe injection practices: we observe activities by anesthesia care providers, RNs and physicians to make sure one needle and one syringe is used for one patient only; the rubber septum on medical vial is disinfected with alcohol prior to piercing; medical vials are always entered with a new needle and a new syringe; single-dose medical vials (SDV) are used for one patient only; multi-dose vials (MDV) are treated as SDVs when located in a patient care area (preop bay, PACU bay, procedure room or operating room); MDVs are appropriately labeled when first opened and discarded after 28 days unless manufacturer specifically states a different date; and pre-drawn medications are labeled with date and time of draw with the initials of the person drawing the medication, medication name, strength, and beyond-use date and time.
3. Diligent sharps safety practices to prevent sharps exposure: appropriate use of puncture-resistant sharps safety disposal containers.
4. Following manufacturer's instructions for use (IFU), current best practice protocols and organizational policy on single-use devices; if single-use devices are reprocessed, they are reprocessed by a FDA approved reprocessing company.
5. Following manufacturer's IFU, current best practice guidelines and organizational policy for sterilization and high-level disinfection of equipment and instrumentation: a suggestion is to maintain a file with the manufacturers IFUs and processing instructions on instrumentation and equipment. Monitor for immediate use steam sterilization (IUSS) to ensure this method is not used for processing implants nor for devices that have not been validated to be processed using an IUSS cycle. If IUSS is performed, follow specific guidelines, manufacturers IFU and organizational policy.
6. Follow manufacturers IFUs with environmental cleaning and disinfection; ensure disinfectants are EPA-registered for healthcare application; monitor for appropriate dwell times and observe healthcare workers using these products to determine knowledge and understanding for use; and ensure daily terminal cleaning of ORs and procedure rooms.
7. Observe staff members performing point-of-care device testing, such as with a blood glucose meter. Ensure hand hygiene is performed before and after use of the device to obtain patient blood samples; observe for gloves worn by healthcare workers when performing blood glucose testing; ensure each finger stick device (lancet and single-use holding device as applicable by manufacturer) is used for only one patient.

We also share in the infection control monitoring and observations with different clinical staff members using these checklists and tools. Often, the preop and PACU teams will conduct observational assessments of the procedure room and operating rooms activities. The procedure rooms and operating rooms staff will conduct these assessments of the preop and PACU areas too.

We share and collaborate on findings at staff meetings and quarterly quality councils. This is a great way to support and reinforce infection control best practices throughout the entire team in your ASC.

Title: Chief Executive Officer
Facility Name: Outpatient CareCenter
City: Birmingham
State: Alabama
How long has your facility been an ASCA member? Five or more years

What measures do you use in your infection prevention and control assessment tool?

We focus on hand hygiene, safe injection practices, decontamination/sterile processing and environment of care. We require appropriate PPE to maintain standard precautions and prevent transmission of pathogens to protect both patients and staff. We perform an annual infection control risk assessment and evaluate any suspected SSI with a tracing methodology. We have a robust employee health program which includes evaluation and treatment of any exposure to blood-borne pathogens.

What is the highest BMI you allow and in what age group?

We do not perform procedures requiring general anesthesia on any patient with a BMI of 50 or greater. We currently have no age limitations.

Title: Administrator/Director of Nursing
Facility Name: North Pines Surgery Center, LLC
City: Conroe
State: Texas
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

Yes.

• Resuming Business Tool Kit (CDC)
• Terminal Cleaning
• COVID-19 Testing Guide (TMA)
• Employee Applications for Unemployment Benefits
• Payroll Protection Plan
• Copies of all Posting Material from CDC, State of Texas
• Texas Medical Board (Addressing Elective Surgeries), etc.
• Visiting Our Facility: A COVID-19 Update
• Interim Infection Prevention and Control Recommendations for Patients
• AAAHC, CMS and State of Texas Updates (notes from every Governor Order)
• Notes from updates by White House Task Force Committee (Dr. Birx & Dr. Fauci)
• Department of Health & Human Services Provider Relief Funding
• Patient and Staff Screening Tools with Updates
• Anesthesia Guidelines for Airborne/Aerosolization of Particles
• ASPR-COVID-19 Healthcare Planning Checklist
• Patient Educational Materials
• AAAHC COVID-19 Risk Prevention: Identify, Isolate and Inform
• CDC Guidance on Preparing Workplaces for COVID-19
• COVID-19 Regulatory Updates
• OSHA and CMS Recommendations for Reopening Facilities
• AHA, ACS, AORN and AHA Joint Statement on Roadmap for Resuming Elective Surgeries after COVID-19 Pandemic
• Every Screening Form on Employees for Every Day of Working
• Screening Tools for Patients Obtained From the Texas Medical Board

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

Staff have and continue to accrue PTO. They may use it when they need it.

Title: Director
Facility Name: Arkansas Specialty Surgery Center
City: Little Rock
State: Arkansas
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

We started a COVID-19 binder in February to use as guidance for the rapidly changing guidelines from the Centers for Disease Control and Prevention (CDC) and the Arkansas Department of Health (ADH).

• Policy and Procedures
• ADH/CDC Directives
• Staff Education
• Screening Tools
• Emergency Preparedness and Response Plan
• Emergency Management Risk Assessment Plan

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

We allow rollover of unused PTO. If employees test positive for COVID-19 on the job, they are not required to use their PTO.

Title: Administrator
Facility Name: South Hills Surgery Center, LLC
City: West Mifflin
State: Pennsylvania
How long has your facility been an ASCA member? Two years

Does your ASC have a COVID-19 binder? What sections are in it?

Yes. It is divided into sections based on the source of the information (i.e., Department of Health, Centers for Disease Control and Prevention, Occupational Safety and Health Administration, etc.). I recently had to upgrade to a large heavy-duty 5-inch binder to accommodate all of the information.

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

There has been no change in our PTO policy. The staff has been utilizing their PTO days, as usual.

Title: Nurse Manager
Facility Name: Huron Gastro Center for Digestive Care
City: Ypsilanti
State: Michigan
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

Our binder is in progress. It covers the steps taken by the practice at the beginning of the pandemic, during partial closure of operations and current procedures that are not standard operating procedures.

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

Our practice allows rollover of all unused PTO. We do not require staff to use all banked PTO before the end of the year.

Title: Administrator
Facility Name: Eye Surgery Center of Chattanooga
City: Chattanooga
State: Tennessee
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

Yes.

• Facility;
• Training;
• Reopening;
• HR/Corporate;
• PPE/Vendors; and
• Guidance.

Title: Nurse Administrator
Facility Name: Evergreen Endoscopy Center
City: South Windsor
State: Connecticut
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

Yes.

• General Information;
• Policies;
• State Regulations;
• CDC Recommendations for Best Practices; and
• Updated Facility COVID-19 Forms such as COVID questionnaire for patients and employees.

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

We allow PTO rollover at our facility.

Title: Administrator
Facility Name: Mankato Surgery Center
City: Mankato
State: Minnesota
How long has your facility been an ASCA member? Five or more years

What do you include in your medication reconciliation forms? Only pharmaceuticals, meds given in the OR or all meds, doses and new prescriptions?

It does include the patient's home medications and those medications that were given in the center if the patient requests. If a new medication was ordered for home, the discharge instruction would list this. The physicians review the list and either resume or hold home medications. The staff have the ability to print the discharge instructions with or without the list of medications given during their stay.

What topics do you cover in your employee handbook?

Introduction of our relationship and expectations, attendance policy, compensation and payroll administration, corrective action, employee drug and alcohol abuse prevention policy, employee assistance program, employment at will, employment classifications, equal employment policy, Family and Medical Leave Act, harassment and offensive behavior policy, Minnesota parenting leave policy, orientation, other leave policies, other benefits of employment, other personnel policies, performance reviews and PTO - extended time off from work.

Title: Director
Facility Name: Menomonee Falls Ambulatory Surgery Center
City: Menomonee Falls
State: Wisconsin
How long has your facility been an ASCA member? Five or more years

Does your ASC have a COVID-19 binder? What sections are in it?

Our facility has COVID-19-specific policies and procedures for staff. Among the issues included in them are:

• Staff expectations for daily screening for COVID-19 symptoms;
• Patient COVID-19 pre-testing requirements;
• Staff on-site social distancing requirements/procedures;
• PPE use and conservation;
• Patient and driver arrival/social distancing requirements; and
• Food handling during COVID.

What is your PTO usage policy? If you don’t allow rollover of unused PTO, are you making an exception this year because of the pandemic?

Our ASC does permit PTO rollover. Because our facility was closed for a number of months due to COVID-19, many staff used PTO to cover their missed work hours. The bigger issue is not one of rolling over unused PTO into next year, but having enough PTO to cover time off in the current year.

Title: Administrative Director
Facility Name: Kelsey-Seybold Clinic
City: Houston
State: Texas
How long has your facility been an ASCA member? Five or more years

Since your ASC has reopened after the COVID-19 lockdown, what specialty is coming back the fastest as far as volume is concerned?

The lockdown certainly impacted volume across all specialties. Since we could resume cases in May, we have returned to 90 percent of our typical volume. Unlike others who have seen growth with GI, we have experienced a higher rate of cases for general surgery, orthopedics and pain management.

If your ASC was planning to add another specialty this year, are you still planning on proceeding, despite the COVID-19 pandemic? If yes, what specialty are you adding?

Our ASC continues to plan for the future during this "new normal" time period. Despite the pandemic, we are evaluating procedures that can be moved appropriately to the ASC. For example, as more spine surgeons transition to the outpatient setting, we are considering adding this service and performing minimally invasive spine procedures in our ASC.

Title: Administrator
Facility Name: St. Joseph Center for Outpatient Surgery
City: St. Joseph
State: Missouri
How long has your facility been an ASCA member? Five or more years

Since your ASC has reopened after the COVID-19 lockdown, what specialty is coming back the fastest as far as volume is concerned?

Our GI cases make up our biggest case volume and they have increased rapidly since restrictions have been lifted. Orthopedic cases have increased regardless of procedure. We test all patients coming to the facility, which has helped case volumes return to normal but does result in a little extra planning on the office end.

Title: Administrator/Director of Nursing
Facility Name: Advanced Pain Management Ambulatory Surgery Center
City: Rancho Mirage
State: California
How long has your facility been an ASCA member? One year

Since your ASC has reopened after the COVID-19 lockdown, what specialty is coming back the fastest as far as volume is concerned?

The pain management case volume has increased the fastest, followed by orthopedics; we are performing more total joint procedures weekly. Podiatry is starting to increase slowly.

If your ASC was planning to add another specialty this year, are you still planning on proceeding, despite the COVID-19 pandemic? If yes, what specialty are you adding?

We are building a new ASC in 2021. The plan is to add various specialties, I believe, but like everyone else we don't have an exact answer at this time. We will see how the COVID-19 recovery progresses. California received an order from the governor in the middle of June that mandated wearing masks while outside due to the increase in cases in our state.

Title: Anesthesiologist
Facility Name: Red Hills Surgical Center
City: Tallahassee
State: Florida
How long has your facility been an ASCA member? Five or more years

Since your ASC has reopened after the COVID-19 lockdown, what specialty is coming back the fastest as far as volume is concerned?

Our experience has been that all specialties have resumed scheduling cases in volumes that are essentially consistent with historic levels of previous procedure volumes.

If your ASC was planning to add another specialty this year, are you still planning on proceeding, despite the COVID-19 pandemic? If yes, what specialty are you adding?

We are a true multi-specialty facility. As such, we are currently performing procedures representative of almost all the major surgical specialties. Consequently, we have not recently considered the addition of an additional line of service.

Title: Director, Ambulatory Surgery Centers
Facility Name: Kadlec Clinic
City: Richland
State: Washington
How long has your facility been an ASCA member? Two years

Since your ASC has reopened after the COVID-19 lockdown, what specialty is coming back the fastest as far as volume is concerned?

I will say that orthopedics would be the primary specialty coming back the fastest in my surgery centers. Despite the prohibition on elective procedures, these ailments need surgical intervention regardless of pandemics.

If your ASC was planning to add another specialty this year, are you still planning on proceeding, despite the COVID-19 pandemic? If yes, what specialty are you adding?

We are looking to add joint replacement procedures to our list of new procedures. These procedures are geared for ASCs and for healthy patients. ASCs are a perfect site of care for these patients.

Title: Administrator
Facility Name: Mankato Surgery Center
City: Mankato
State: Minnesota
How long has your facility been an ASCA member? Five or more years

How are you keeping in touch with your staff/furloughed staff? Is it through Zoom or any other mechanism?

We started with call in number for conference call in the beginning. We found WhatsApp to be helpful for sharing information and for uploading policy or procedure changes. The managers also have had open communication with those out due to low census. We did not close our center, so continuous communication was a great thing the team has done to stay connected.

Title: Executive Director
Facility Name: Pend Oreille Surgery Center, LLC
City: Ponderay
State: Idaho
How long has your facility been an ASCA member? Five or more years

Given COVID-19, does staff need to be retrained on infection control policies, specifically proper donning and doffing of PPE, hand hygiene and environmental cleaning?

All of these areas require annual training regardless of the virus/organism du jour. The COVID-19 pandemic should not have any bearing on staff education on proper use of PPE, hand hygiene or cleaning/disinfection of patient care areas and high-touch surfaces.

An annual PPE fashion show is always a big hit! Have business office staff dress in PPE and model for the clinical staff. Have clinical staff identify areas where donning and doffing are not quite in compliance with recommended practices. For instance, gown cuffs over glove cuffs, hair not completely contained in bouffant, mask under nose, etc.

Certainly times such as this help us all to be extra vigilant but the processes and practices remain the same no matter the current events.

Title: Administrator
Facility Name: Mankato Surgery Center
City: Mankato
State: Minnesota
How long has your facility been an ASCA member? Five or more years

Certain ASCs are sewing masks to help their healthcare community fight the dearth of PPE in the current COVID-19 pandemic. Is your ASC doing anything special to help your community combat the crisis?

We did slow down to doing "essential" cases only, continued to screen patients and employees, and implemented CDC phases of PPE use. The slowdown gave our state time to assess the PPE needs in the state. We met with the Minnesota governor's office to review the surgery centers in Minnesota and our role for the state. We outlined information on our PPE and anesthesia machine use and were ready to help the state if needed.

I started a mask production group to help our community. We used an operating room material used for sterilzing our equipment to make the masks, and that has been sucessful. We made close to 5,000 masks and gave them to our local clinic owners, long-term care facilities and other crisis centers that had a mask shortage.

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

We reviewed our PPE and items on back order to make sure that these items were available in a timely manner to perform scheduled surgeries. We did not close, we were open to doing those cases deemed "essential" according to the Minnesota governor's executive order.

Title: Chief Executive Officer
Facility Name: Santa Cruz Surgery Center
City: Santa Cruz
State: California
How long has your facility been an ASCA member? Five or more years

Certain ASCs are sewing masks to help their healthcare community fight the dearth of PPE in the current COVID-19 pandemic. Is your ASC doing anything special to help your community combat the crisis?

We hosted a drive-by antibody testing event where 130 healthcare professionals came by to get tested. We shared the results of the tests that we received, we had zero positive results.

We also would give out care packages, containing a mask, Purell and toilet paper, to patients when they came in for emergency surgery. It was a big hit, especially, the toilet paper.

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

We never closed.

Title: President and Chief Executive Officer
Facility Name: Mississippi Valley Health
City: Davenport
State: Iowa
How long has your facility been an ASCA member? Five or more years

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

We closed our endo facility for a couple of weeks and then re-opened the week of April 13, 2020—just two days a week—to help take the burden off the hospital endo department. Our multispecialty ASC has been open the entire time but only performing surgery on Tuesday and Thursdays. We are performing “necessary surgeries” only. Same thing with our endo facility. Some of our team members have taken temporary assignments to assist with COVID-19 testing, others have decided to stay home because they have small children to care for or older family members who need assistance. We have supported each staff member in their decisions based on their individual circumstances.

Title: Clinical Director and Total Joint Coordinator
Facility Name: Constitution Surgery Center East
City: Waterford
State: Connecticut
How long has your facility been an ASCA member? Five or more years

Certain ASCs are sewing masks to help their healthcare community fight the dearth of PPE in the current COVID-19 pandemic. Is your ASC doing anything special to help your community combat the crisis?

We made a donation of surgical masks with eye shields to the local fire and ambulance department. Several of our talented employees are also sewing and donating cloth masks for the local community.

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

It was recommended by the two local area health networks—Yale New Haven Health System and Hartford Healthcare—that our ASC remain open to decompress the local hospitals of emergent and urgent cases during this pandemic. We telephone screen every patient within 24 hours of arrival, check their temperature prior to entering the building and have prohibited visitors within the ASC. We anticipate continuing these practices once the emergency declaration is lifted and are investigating the many serology and/or point-of-care testing kits becoming available via the FDA's Emergency Use Authorization. We maintain a good supply of PPE, have reviewed all infection control practices, and are following all FDA recommendations.

Title: Clinical Manager/Assistant Director
Facility Name: Kona Ambulatory Surgery Center
City: Kailua-Kona
State: Hawaii
How long has your facility been an ASCA member? Two years

Certain ASCs are sewing masks to help their healthcare community fight the dearth of PPE in the current COVID-19 pandemic. Is your ASC doing anything special to help your community combat the crisis?

We have volunteered to be the donation site to collect items donated by our community. My surgical team inspects the donated items and inventories them for use by our hospital. This has been rewarding for us to be able to support the hospital and our community.

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

We have suspended cases following our governor's stay-at-home order. We are working on creating a protocol for reopening in May. Prior to closure, we had increased our screening process with preop and all employees. Now with the community spread of the virus, we are trying to decide if we will require lab testing prior to surgery for all patients. We are also prepared to assist the hospital as needed if there is to be an influx of patients.

Title: Administrator
Facility Name: Oregon Surgical Institute
City: Beaverton
State: Oregon
How long has your facility been an ASCA member? Two years

Certain ASCs are sewing masks to help their healthcare community fight the dearth of PPE in the current COVID-19 pandemic. Is your ASC doing anything special to help your community combat the crisis?

Last week, one of our coworkers read an article about repurposing sterile processing wraps. These wraps are virtually impermeable. We gathered our entire team, along with doctors, physician assistants and reps, and started to sew. Most of us have never used a sewing machine, but together we made 175 masks to share with our families, friends and local MD offices. We made adult-sized, child-sized and toddler-sized masks. Additionally, we gave 1,800 surgical masks to our two local hospitals, Legacy and Providence.

We know that we are not on the front line, but we are keenly aware that we have the ability and the resources to hopefully make a difference.

If your ASC is temporarily closed, what are you doing now to make certain you can reopen safely and quickly once the emergency declaration is lifted?

We are not completely closed. We have a group of trauma doctors on our team, so we have been continuing to see those patients in need of emergent/urgent surgeries. This has been good for staff and for our community, as we are still serving in a capacity that affords patients the ability to have a necessary surgery in a safe environment. With this, we have certainly tightened up our screening process and are following guidelines similar to the hospitals, e.g., extensive screening, no visitors in the lobby, temperature screening for everyone who walks through the door and all staff, and rescheduling if anything falls out of compliance with the guidelines. We are prepared if we need to act as a resource center for the hospitals, as well as prepared to get back to business as usual, whenever that might be.

Title: Director
Facility Name: Menomonee Falls Ambulatory Surgery Center
City: Menomonee Falls
State: Wisconsin
How long has your facility been an ASCA member? Five or more years

What kind of conflict resolution strategies do you use in your center?

We encourage staff and teams to meet directly and work together to resolve issues. They are coached on basic conflict resolution skills, such as focusing on the behavior or problem and not the individuals; effective listening techniques; identifying issues they agree and disagree on; and developing a plan to resolve the issue. If the individuals or team are unable to come to an agreement or formulate a plan, the manager might need to intervene to facilitate a resolution.

What topics would you like to see covered more at ASCA’s annual conference?

I think the next ASCA annual conference might be a good time to have presenters focus on the aspects of how various ASCs responded to and recovered from COVID-19.

Title: Director
Facility Name: Surgery Center of Wisconsin Rapids
City: Wisconsin Rapids
State: Wisconsin
How long has your facility been an ASCA member? Four years

What are the top three priorities of your ASC this new year?

How does your ASC store Propofol?

We keep a PAR [periodic automatic replenishment] level in our anesthesia cart. The remainder of the Propofol is kept in a locked room. Each day, when the Propofol is restocked in the anesthesia cart, the number of vials removed are signed out. We keep a running total of the number of vials locked in the room and in the anesthesia cart. At the end of each week, we manually count all Propofol to make sure the number matches our running total. This manual count is signed by two staff members.

Title: Administrator
Facility Name: Southwestern Ambulatory Surgery Center
City: Pittsburgh
State: Pennsylvania
How long has your facility been an ASCA member? Five or more years

What are the top three priorities of your ASC this new year?

Patient safety

Adding new procedures

Recruiting new surgeons

How does your ASC store Propofol?

Locked with our controlled substances. We treat it like a controlled substance and account for all usage.

Title: Clinical Director
Facility Name: Baylor Scott & White North Garland
City: Garland
State: Texas
How long has your facility been an ASCA member? Five or more years

How does your ASC store Propofol?

Our ASC stores Propofol in our locked medication room. The nurses count it out for the anesthesiologist and place it in their medication box in the morning based on their case load. It is documented on the controlled substance administration record, wasted and witnessed, same as a narcotic.

The remaining vials are reconciled at the end of the day with the RN in the OR. This is not m

Title: Administrator
Facility Name: The Surgery Center
City: Middleburg Heights
State: Ohio
How long has your facility been an ASCA member? Five or more years

What are the top three priorities of your ASC this new year?

1. Case growth.

2. Cost containment.

3. Staff cross training.

How does your ASC store Propofol?

Locked in our narcotic safe in our locked narcotic room.

Title: Quality Improvement, Clinical Compliance, Infection Control
Facility Name: Parkway Surgery Center
City: Myrtle Beach
State: South Carolina
How long has your facility been an ASCA member? Five or more years

How does your ASC store Propofol?

Before July 2019, our facility stored Propofol in a locked cabinet in the anesthesia work room and anesthesia staff would just take what they felt they needed daily. Since that time, we have switched our anesthesia management company that contracts our CRNAs. They are based out of Georgia, which is one of two states that treats Propofol as a controlled substance; because of that we are required to treat Propofol as a controlled substance. We now store Propofol in a double-locked cabinet. It is counted in the am and, depending on the caseload, an allotment is signed out to anesthesia. During cases, anesthesia documents the amount of Propofol administered to each patient. After the case any Propofol left in the vial not administered to the patient is wasted in our controlled substance waste system, witnessed and documented. At the end of the day, anesthesia returns any unused vials to the double-locked cabinet, and the pm count is conducted.

Title: President and Chief Executive Officer
Facility Name: Mississippi Valley Health
City: Davenport
State: Iowa
How long has your facility been an ASCA member? Five or more years