COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


WE STILL NEED YOUR HELP- SEND IN YOUR ACF LETTER IF YOU HAVE NOT DONE SO ALREADY! – 4/7/20
Thank you for the tremendous response to our request for letters regarding the ACF.
Some two dozen have been included as  attachments to the Commissioner .
Now begins the negotiations!

SBA LOAN- SEND A LETTER TO YOUR REPRESENTATIVE TODAY – 4/7/20
The SBA loan has issues for some ASCS- particularly those with a hospital partner and/or management company. These are considered majority owners and thus the loan application would be aggregated.  Here is a good template to send a letter to your Representative concerning this issue.

QUESTION ABOUT PPE AND EQUIPMENT – 4/7/20
Q: If a center voluntarily donates PPE, ventilators etc to a hospital should it let OEM know? If so, how?

A: The facility can notify the county OEM as a courtesy, but it is not required.
 
Stefanie Mozgai, BA, RN, CPM
Assistant Commissioner
Department of Health

ASCS TEMPORARILY ENROLLING AS HOSPITALS - - 4/6/20
Here is additional guidance from CMS.


ADDITIONAL GUIDANCE FOR SBA LOANS- HOSPITAL AFFILIATES - 4/6/20
Please make sure you understand the parameters for the SBA loan filing. Additional clarification- tests- were made available on Saturday, to see if you qualify, if you have a hospital partner/management company.


JOIN THE WEBINAR TODAY- RECENT NJ & CMS TELEHEALTH REGULATIONS - 4/6/20

ACF TAX RELIEF REQUEST LETTER SENT TO DEPARTMENT OF HEALTH – 4/3/20
Thank you for the tremendous response to our request for letters regarding the ACF.
Some two dozen have been included as attachments to the Commissioner .
Now begins the negotiations!
 
EXECUTIVE ORDER 113
Here is the full text of Executive Order 113 allowing for the potential commandeering of PPE and other vital equipment.


STATE POLICE HAS POWER TO COMMANDEER PPE AND EQUIPMENT 4/2/20
Today Governor Murphy announced a new EO- it is not finalized yet, that gives the state police the power to commandeer medical equipment and supplies from businesses that have stocks and have not yet donated to any hospitals. The Governor further stated that he hopes the state police will not have to use this order, but he wanted it in place.


AAAHC CHANGES AND INFORMATIONAL WEBSITE - 4/2/20

Dear AAAHC Organization,

Due to the evolving COVID-19 outbreak, until further notice, AAAHC is waiving the Change Notification requirement for clients with service scope changes directly associated with COVID-19. These include temporary closures and suspension/expansion of services.

For more information, please visit  www.aaahc.org/covid-19

Sincerely,
The Accreditation Association for Ambulatory Health Care


MORE PHARMA INFORMATION - 4/2/20
Things to remember if you are closed.



EXECUTIVE ORDER 112 – 4/2/20
This EO is important as it defines and relaxes rules for healthcare professionals looking to volunteer and assist.
They would have immunity from liability.



PLEASE CONTINUE TO VOICE YOUR OPINION ON THE ACF – 4/2/20
A lot of centers responded yesterday, but we need more.
Below is a sample that you can use to state your cases.
 
Then e-mail to:  shoisington@msnj.org
 
I am the Administrator of ___________  .  _________  has been serving the community providing quality outpatient surgical care since 1985. We have been paying the ambulatory care facility gross receipts assessment at the maximum rate since its inception. 
Due to the catastrophic events restricting our ability to provide patient care, our finances are at a critical level. Our case volume has decreased from 200 patients a week to 10. Yet our fixed costs remain constant. We have been working with our hospital partner to redeploy clinical staff, but we still have payroll costs including health insurance and other benefits, and other operating expenses. Without financial relief, we are not going to be able to continue meeting these obligations.
We need to maintain our facility in a state of good repair to be able to quickly ramp up to handle the surgical volume after this crisis has ended. We will also most likely need to replace equipment and supplies that will be reallocated to other providers needed to treat COVID-19 patients. We are predicting the cost of these goods and services to be significantly higher.
In the spirit of Governor Murphy’s efforts to protect New Jersey’s health care delivery system and small businesses, we are seeking relief from the New Jersey Ambulatory Care Assessment. That money will be much needed for investment back into our surgery center so that we may resume normal operations as quickly as possible. 
We thank you for your efforts to allow us to voice our grave concerns.
 
Respectfully,


ACF RELIEF – 3/31/20
I have gotten calls and e-mails from centers about the ACF.
Last Friday in the COVID e-blast I posted from our lobbyist and from Larry Downs from MSNJ.
Today I was told that no ASCs have responded! He needs this to help make the case, please assist.
You need to get this done if you want tax relief.

IS YOUR BUSINESS PROTECTED? – 3/31/20
Join the Brach Eichler Webinar

UPDATED ICAR INFORMATION – 3/31/20
SARS-CoV-2 (COVID-19) is currently circulating in New Jersey and the surrounding areas with many healthcare workers and facilities being heavily impacted. Please see below and attached for a quick overview of updated resources and guidance for healthcare personnel.
 
As always please continue to review federal, state, and local partner resources. Some resources of interest may include:
 
 
Jessica Arias, Bridget Farrell, Carol Genese, and Melody Lee
Infection Control Assessment Response (ICAR) Team

FAMILIES FIRST ACT- Q&A- 3/31/20

FAMILIES FIRST ACT- Q&A- 3/31/20
Tonight CMS released information concerning  regulatory changes  to allow the U.S. healthcare system to address the expected patient surge from the COVID-19 outbreak. Under the “hospitals without walls” program, hospitals will be able to transfer patients to outside facilities, including ASCs, while still receiving hospital payments under Medicare. ASCs will be able to contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan.
 
We will be holding a special update call for State Leaders tomorrow at  11 a.m. ET  to provide updates on these regulatory changes and what they mean for ASCs. Dial-in information for the call is listed below and a calendar invitation will circulated shortly. 

SURGE CAPACITY/ SPILL OVER—CONCERNS AND ISSUES – 3/31/20

Here are some talking points and a breakdown based on some primary concerns:
 
Managing narcotics: The ASC would operate like a "unit" in the hospital. So if the hospital issues narcotics out of their primary stock they will need to track them on a narcotic sheet and record each medication used on each patient. They can also track waste on this sheet. I would keep medications secure in a box with a lock. On a hospital floor they would be in a narc box or an automated dispensing machine until the meds are used. So an anesthesia type box could be used. I would have the narcotic sheet counted with two RNs at the end of each shift. And then return them to the "primary storage location" if the ASC doesn't remain open for 24 hours. 
I would recommend that we participate in the management of drug security in coordination with the hospital. Another option is to use a pharmacy such as Devines pharmacy and fill medication orders as an outpatient prescription. 
 
Managing Medications: I would assume medications would need a pharmacist review if the ASC is functioning like a hospital. We are offering  24/7  oncall coverage for medication verification. 
They would need the orders faxed over, RPH reviews, and sends back a fax stating the orders are reviewed. Obviously we would need pertinent information: Allergies, Scr, Ht, Wt, etc. 
We currently have this service in place at 4 PA surgical hospitals. It would be seamless to provide this service. 
 
Formulary Management: I would assume the ASC would just adopt the formulary of the hospital they are working with. Or fill medications thru an outpatient pharmacy. JDJ could provide coordination. Bigger question is how the ASCs will get the medications they need to their facilities? If they are doing "emergency fracture surgeries" it would be prudent to review the order set at the hospital and ensure those medications are onsite at the ASC.
 
Drug Information: Many ASC staff are not trained at a critical care level. So perhaps our greatest use would be drug information. The questions we answer daily oncall. How long to run this antibiotic? i.e. Vancomycin over 90-120mins, Cefazolin over 30 mins, etc etc. Also how fast to push a medication. More so the medications that the staff may not be familiar with. Drug interactions should also be reviewed using Lexicomp or some other software.
 
If they run these ASCs like Urgent care facilities I do not believe our services will be as demanding other than drug information. If they classify them like hospitals then what I suggested above may apply.
Be safe
John k
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com