A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
This website uses cookies. to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking “Accept & Close”, you consent to our use of cookies. Read our Privacy Policy to learn more.
By: Jared Bilski
Published: 7/14/2020
When the American Cancer Society recommended colonoscopy screenings should start at age 45 instead of age 50 last May, you might have wondered how you were going to accommodate the influx of new patients. Fast forward one year and a global pandemic later, and you're probably wondering how you'll convince reluctant patients to get their screenings done so your case volumes return to the level they were before COVID-19.
Physicians at the Center for Digestive Health & Nutrition in Moon Township, Pa., typically perform approximately 5,000 colonoscopies each year. During the height of the pandemic, when elective procedures were put on hold and only colonoscopies that met the strict definition of emergent were being done, the facility saw an 80% to 90% reduction in their normal screening volume.
"We would run three rooms, three days a week and then two rooms, two days a week," says Frank Kim, MD, a gastroenterology specialist at the center. "During the worst of it, we were scheduling cases on only one morning."
Thankfully, the center's case volumes are nearly back to where they were before the coronavirus outbreak. But the entire patient scheduling and procedural process is far different than it was pre-pandemic. Let's look at everything you're likely to encounter as you get your colonoscopy service line back to a stable, consistent level.
Indeed, that's the situation Mohammad A. Al-Haddad, MD, is facing. "We're still seeing a significant number of last-minute cancellations which occur within three days of the procedure," says Dr. Al-Haddad, a gastroenterologist with Indiana University Health in Indianapolis.
He points out patients might become anxious about entering a healthcare facility, change their minds or view the screening as a test that can wait another year.
There's another major reason for the cancellations. "One of our biggest issues has been the pre-screening COVID test," says Dr. Al-Haddad.
"We now ask every patient to get tested. Unfortunately, some patients cannot get tested or refuse to get tested, and they fall off the schedule."
Like many facilities, IU Health's outpatient endoscopy centers saw a 75% reduction in volume between the end of March and the beginning of May, when physicians were performing only emergent and urgent-access colonoscopies. In late June, its colonoscopy volume was back up to three-fourths of its pre-COVID-19 levels, at least in part because of the facility's patient outreach efforts. When staff repeatedly heard from patients who didn't want to undergo screenings, they took a more aggressive approach.
"We developed a brief training program to teach schedulers how to better communicate with reluctant patients," says Dr. Al-Haddad. "The program helps them reassure patients, talk them through anxieties and share the facilities' safety data."
If a scheduler is having trouble convincing a patient, they can request back-up. "The advice of a nurse is sometimes more impactful in changing a patient's mind," says Dr. Al-Haddad.
All GI facilities should stick to the same basic blueprint when ramping up colonoscopy volumes for as long as COVID-19 plays a major factor in the screening equation, according to Mohammad A. Al-Haddad, MD, a gastroenterologist with Indiana University Health in Indianapolis. Here are ways to ensure screenings are rescheduled safely and appropriately:
1. Useful stats. Research the prevalence rate of coronavirus antibodies and antigens in your community and state. Low numbers could allay the fears of hesitant patients, who might otherwise cancel their cases. High numbers could cause you to rethink your plans to increase case volumes.
2. Updated protocols. Create written policies for new cleaning protocols, PPE allocation, supply chain management, COVID-19 screening and how to respond if a patient, staff member or physician exhibits symptoms of infection. Be ready to adjust these documents often.
3. Constant communication. Provide schedulers and nurses with talking points about these updated policies to share with patients. Keeping patients informed could reduce their anxiety about receiving care during a pandemic. Your staff should also remind reluctant patients about the importance of their upcoming screening and why it shouldn't wait.
— Jared Bilski
Dr. Keswani, who recently co-authored a detailed report on reactivating outpatient GI practices (osmag.net/ppQAR5), says your physicians need to play a more active role in engaging patients. "Whenever possible, they should reach out to patients to remind them about the importance of screenings, especially if they have a family history of colon cancer," he says.
"That dialogue between physician and patient is much more likely to result in the patient agreeing to get screened."
There's no one-size-fits-all approach to ramping up your colonoscopy service line in the era of COVID-19. "A small endoscopy center in a rural county is not the same as an urban center in the middle of a bustling metropolis," says Dr. Al-Haddad.
While there's no doubt a very compelling business reason to get your colonoscopy service line back to pre-pandemic levels, there's an even more powerful patient-driven reason to make sure people don't forego critical care that can still be done safely. "We don't call colonoscopies elective procedures, we call them life-saving procedures," says Dr. Kim. "If patients have colon polyps and we get them out, we've saved their life." OSM
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
In her 24 years as a nurse at Penn Medicine, Connie Croce has seen the evolution from open to laparoscopic to robotic surgery....
Through my decades of researching, testing and helping implement healthcare design solutions, I’ve learned an important lesson: A human-centered and evidence-based...