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The COVID-19 PHE also caused a dramatic shift in most vascular surgeons’ practices. Aziz et al found that 82% of vascular surgeons were operating at VASCCON 3 (“severe limitations of non-emergency surgery”) or lower during the early pandemic, indicating higher acuity with greater limitations in surgical care. Many reported decreases in clinic referrals, inpatient consultations, and emergency department consultations Although the majority noted that these limitations lasted 4 weeks or less, survey respondents in lower VASCCON levels reported longer durations of practice changes as well Providers in COVID surge areas seemed disproportionately affected by these disruptions. For vascular surgeons practicing in outpatient clinics and ambulatory care, 89.2% had reported changes in their practice, including limited hours (71%) and use of telehealth services (81.1%) Expansion of telemedicine has particularly been supported by the Department of Health and Human Services and Centers for Medicare and Medicaid Services through reimbursement parity for in-person and virtual patient visits and expanding telehealth coverage to a wider array of visits For surgeons with office-based laboratories, only 48.8% remained open and were largely limited to emergent procedures, such as dialysis access and peripheral arterial disease However, 74.4% of respondents reported continuing vascular laboratory activity, although many reported adjusting their usual practices in response to the pandemic Inpatient services were also significantly impacted. Hemingway et al reported the Harborview Medical Center experience, where clinical volume decreased by 96.5%, surgical volume decreased by 71.7%, and inpatient consultations decreased to only 1.81 per day. When comparing clinical activity from 2019 to 2020, Fang et al found that professional productivity decreased by 51%, professional claims reimbursement decreased by 54%, and hospital claims reimbursement decreased by 47% Clearly, the overall impact on vascular surgery has been profound. The severity of the COVID-19 PHE required an unprecedented mobilization of national health care resources and workforce in response. However, this also resulted in a dramatic shift in the allocation of such resources within medicine. The need to minimize exposures and limit valuable items, such as PPE, necessitated an extensive triage of common medical problems on a national and global scale. As such, many medical practices shut down, both temporarily and permanently, and most hospitals limited non-COVID care to emergencies only. Although these measures in response to the COVID-19 PHE were appropriate, it has caused a tremendous and historic negative economic impact on the health care industry. Early in the COVID-19 PHE, estimated losses in US hospitals were $50.7 billion per month The most recent estimate of total losses sustained by the US health care system is more than $320 billion—a staggering amount In March 2020, an unprecedented 42,500 jobs were lost in the health care sector A report by the Medical Group Management Association found that 97% of medical group practices experienced a negative financial impact during the COVID-19 pandemic. In US hospitals, inpatient admissions decreased by 30%, emergency department visits decreased by 40%, and observation services decreased by 47% Practices reported an average 60% reduction in patient volume Providers experienced pay cuts, furloughs, layoffs, or early retirement due to the financial pressures of the pandemic, and many remain at risk of losing their practices, given the lack of revenue In addition to lost revenue, the need for PPE, screening and testing of patients and staff, and capital costs related to the expansion of telehealth technology are all novel expenses now essential to practicing medicine in the COVID-19 era Furthermore, caring for patients with COVID-19 has come at significant expense; the cost for treating a patient with COVID-19 begins at around $20,000 and can increase to more than $80,000 if ventilator support is required However, reimbursement for their care often does not match their complexity and the loss from COVID-
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