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.


PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT. 
TO VIEW PREVIOUS E-BLASTS, CLICK HERE

UPDATE ON GOINGS ON – 5/27/20
All:
It has been trying for all of us, but rest assured NJAASC is working on a lot of the issues we are facing.
 
We should have an answer very soon as regards PPE and case load reporting. It appears that we are going to co-opt the hospital portal- have a click for ASCs on there, being finalized.
 
We have also approached the Department as regards pediatric patients, as it appears labs are choosing not to test them, refusing.
 
This AM I sent a letter to the Department as regards all the major pharmacies. Walgreens, CVS, Walmart etc., are not doing pre-op COVID testing- these patients do not meet their criteria. We of course knew this would happen as we tried prior to the guidelines to register just to see what would happen!
 
Tomorrow or Friday, NJAASC will have a reporting tool to send to all ASCS wherein you can record issues you are having with testing.
This will allow NJAASC to collate all the data and present it to the Department, to hopefully get things changed.
 
Finally, we are still working on the Ambulatory Assessment, several options are in the offing right now.

THE ASC GUIDELINES ARE NOT SUGGESTIONS! – 5/27/20
I just want to make sure everyone understands that the ASC Guidelines issued by the Department are not optional, or suggestions.
THEY ARE NOT DISCRETIONARY!

You need to make this clear to your doctors and anesthesia.
I have heard that some are taking the position that; ‘they are only guidelines’.
Well go right ahead with that line of thought and see where it gets you!
The guidelines are part of an Executive Order- EO 145, they are not recommendations.
 
If anyone has knowledge of this occurring, I would suggest that you make sure NJDOH knows about it.
We cannot afford to have bad apples spoil our ability to do elective cases, and trust me if enough abuse occurs I have no doubt the Governor would rescind.
We may not like the guidelines, but that is not the point. They are here for the time being. There is no way cases are going to be allowed to be performed without testing.
Thus, we must work with the Department, Governor’s Office, DCA -everyone, to try to make them practical.
And that is exactly what NJAASC has been doing for the past several weeks.

PPP Update: The Regulation Relating to Loan Forgiveness - 5/27/20
Shortly after the Small Business Administration (SBA) issued the Paycheck Protection Program (PPP) loan forgiveness application form, it issued the  regulation relating to loan forgiveness . Here are the main takeaways from the regulation that we learned in addition to what was provided for in the loan forgiveness application form:

The Forgiveness Process
  • At least 75% of the loan forgiveness amount must be for payroll costs. 
  • For loans that are not reviewed by the SBA prior to the lender forgiveness decision, the lender will have 60 days from receipt of a loan forgiveness application to issue its forgiveness decision to the SBA. The lender will be responsible to notify the borrower of the forgiveness amount. Any amount not forgiven must be repaid by the borrower on or before the two-year maturity of the loan. 
Forgiveness Reduction
  • Employers will not lose forgiveness for employees whom are offered rehire, or who are offered restoration of an hours reduction at the same rate of pay, even if the employee does not accept the offer. Employers must document the offer to the employee and the employee’s rejection of same. 
  • Employers will be required to inform the state unemployment insurance office of the employee’s rejected offer of reemployment within 30 days of rejection of the offer (more guidance is expected on this new item).
  • Employers that restore, by June 30, 2020, any reduction in FTEs that occurred between February 15 - April 26, 2020 as compared to one of two statutory periods, will not lose forgiveness based upon the FTE reduction.
  • Loan forgiveness will not be reduced if an employee is fired for cause, voluntarily resigns, or voluntarily requests a schedule reduction. 
FTE Calculation
  • The SBA is using a 40-hour workweek standard for FTE calculation. Any employee who works 40 hours or more each week is considered as one FTE.
  • An employee who works less than 40 hours per week may be counted as a half (.5) FTE. 
  • Alternatively, as to employees who work less than 40 hours per week, the employer may calculate the average number of hours per week during the covered period compared to the 40-hour workweek. For example, if the average number of hours per week is 30, then that employee would count as a .75 FTE, and if the average number of hours per week is 10, then that employee would count as a .25 FTE. 
Payroll Costs
  • Payroll costs are generally incurred on the day the employee’s pay is earned. Employee pay is generally “earned” on the day the employee worked. For employees who are on the payroll but not working, the payroll costs are incurred on the schedule established by the borrower (typically the day the employee would have worked).
  • Only borrowers with a payroll cycle that is bi-weekly or more frequent may use the alternative covered payroll period. That is, the eight-week period that begins on the first day of the first payroll period beginning after receipt of the loan proceeds.
  • Bonuses or hazard pay paid to employees during the covered period are permissible payroll costs (subject to the annualized cap of $100,000 per employee, or $15,385/employee).
  • Owner-employees and self-employed individuals’ forgivable payroll compensation can be no more than eight weeks of their 2019 compensation or $15,385 per individual in total across all businesses. And no additional forgiveness is provided for retirement or health insurance contributions for self-employed individuals, including Schedule C filers and general partners, because such expenses are paid out of their net self-employment income.
  • Owner employees’ loan forgiveness request is capped by the amount of 2019 employee cash compensation and employer retirement and healthcare contributions made on their behalf.
  • Schedule C filers’ loan forgiveness is capped by the amount of their owner compensation replacement, calculated based on 2019 net profit. 
  • General partners’ loan forgiveness is capped by the amount of their 2019 net earnings from self-employment (reduced by claimed section 179 expense deduction, unreimbursed partnership expenses, and depletion from oil and gas properties) multiplied by .9235. 
Nonpayroll Costs
  • Nonpayroll costs are eligible for forgiveness if paid during the covered period or, incurred during the covered period and paid on or before the next regular billing date, even if the billing date is after the covered period.
  • The SBA’s example relates to a borrower who has a covered period of June 1 - July 26. According to the SBA, the borrower pays its May and June utility bill during the covered period and should be forgiven. The SBA also allows the borrower to be forgiven for the portion of its July utility bill (through July 26) because it was incurred during the covered period and paid on the next regular billing date after the covered period.
  • Advance payments of interest on a covered mortgage obligation are not eligible for loan forgiveness.  

THE FIRST DAY OF ELECTIVE SURGERY – HOW DID YOUR CENTER DO?--5/26/20
So hopefully everyone made it through the first day of elective surgeries, relatively unscathed!
This is a process and like all of them we need to iron things out, and make the process work better, and that requires your assistance.
 
To that end, NJAASC has asked that all ASCs keep a log of glitches and the like so we can talk to NJDOH and if need be, get things changed.
We need to collect data, so assist:  https://conta.cc/36pvwz6
 
We will be distributing a reporting document later this week.

STANDING ORDER FOR COVID TESTING – 5/26/20
Please make sure that you received and read the Standing Order regarding COVID testing from two weeks ago.
 
Important in that it mandates no RX needed.

PPE & CASE LOAD REPORTING – 5/26/20
The guidelines mandated PPE and case loads reporting.
Unfortunately ASCs right now have no way to comply.
Per DOH- until a means has been established, ASCs do not have to worry about this issue.

PATIENT TESTING AND RESULTS – 5/26/20 
Please make sure that you have results of negative testing before the patient walks through your doors!
By that I mean a patient ‘assuring’ you that they were tested and results were negative, and will bring them on day of surgery is not the way to do things.
The center must either have the results in their hands, or have results telephonically by checking with the lab, or from the doctor who also has either the actual results, or was telephonically notified by the lab.

SAMPLE TEMPLATE LETTER FOR HOSPITAL TRANSFER – 5/22/20
As promised, here is a sample template letter to be used to inform your hospital transfer that you are doing surgeries as of 5/26/20.
This is what DOH recommended ASCs do.
You DO NOT have to contact your hospital transfer every day.

PLEASE HELP NJAASC WITH TESTING AND 96 HOUR RULE- 5/22/20
We need to collect data so we can present it to DOH to support our contention that there is not the capacity nor the turn-around for the testing requirements.

CATCH THE NJAASC ASC GUIDELINE WEBINAR HERE – 5/22/20
If you were unable to join us on Thursday, here is the link for the webinar.
I would strongly suggest you take advantage.

DATA ELEMENTS TO MONITOR FOR COMPLIANCE WITH GUIDELINES- 5/22/20
Below find comments from the Department as regards this issue, as well as the website- the COVID DASHBOARD that was mentioned on the webinar.
 
Hi Jeff, no need for you to know these data elements and for you to report on them but they are available:
Ambulatory surgery centers can resume procedures based on the following capacity data from the Hospital the facility has a transfer agreement as required in d.4. The hospital shall have downward trajectory calculated using the average of the three most recent days:
1.                    Influenza Like Illness (ILI) or COVID-19 like syndromic cases;
2.                    COVID-19 infection rates;
3.                    COVID-19 hospitalizations;
4.                    COVID-19 emergency room admissions;
5.                    COVID-19 Intensive Care Unit (ICU), Critical Care and Medical Surgical bed utilization;
6.                    Ventilator utilization; and
7.                    Ventilator availability.
 
Ambulatory Surgery Centers do not have access to these data. Please clarify the frequency of this requirement. 
 
All you would need is to monitor the data available on the public website and three day averages and those are part of the COVID Dashboard Here https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml

ONE ROOM LICENSURE SURVEYS TO RE-START – 5/22/20
While not technically a COVID related piece of information, it is nonetheless an important one!
DOH has informed me that they are re-starting one room licensure surveys the week of June 1 st , they have several scheduled.
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com