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19 care alone was $36.6 billion from March to June 2020 in US hospitals On March 14, 2020, the US Surgeon General recommended ceasing all elective procedures This was in line with several societal recommendations, as well as local governmental mandates to limit exposures and concentrate valuable health care resources toward the care of patients with COVID-19 Although a necessary intervention, the cessation of nearly all elective operations had a major financial impact on the US health care system. During the first 4 months for the COVID-19 PHE, US hospitals lost an estimated $161.4 billion in revenue from the cancellation of elective services, including surgical procedures Generally, elective operations involve the highest margin of reimbursement and surgical volume often accounts for nearly half of a hospital's revenue In addition, overhead related to operating room facilities and equipment persisted despite the lack of surgical revenue. Considering the median operating margin of 2% for US hospitals, this has resulted in a precarious financial situation; ambulatory surgery centers, the profitability of which similarly relies on operative volumes, remain even more vulnerable due to their smaller budgetary margins The Coronavirus Aid, Relief, and Economic Security (CARES) Act included several measures intended to lessen the financial burden on the health care system. It allocated $100 billion in emergency funds distributed to providers with lost revenue due to COVID-19, of which $10 billion will go directly to hospitals in high COVID areas and $10 billion to rural health clinics and hospitals [It also increased reimbursement for inpatient COVID-19 admissions by 20% and reduced payroll taxes by 50% for improved employee retention Through the Paycheck Protection Program and Health Care Enhancement Act, an additional $75 billion was added to the relief fund for health care providers Furthermore, independent physician practices might be eligible for small business loans through several programs created through the CARES Act The Department of Health and Human Services responsible for the distribution of federal funds; however, in an effort to quickly implement distribution of funds to prevent insolvency of hospitals nationwide, the distribution of funds was far from equitable In distributing at least the first $50 billion of funds to hospitals, hospitals received funds proportional to their previous years’ revenue. This caused a much higher proportion of bailout funds to flow to large academic centers and hospital chains with profitable patient-payer mixes and much less going to safety-net hospitals supporting poor and diverse communities. Per a review of hospital finances by the Washington Post and Kaiser Health News, Baylor Scott & White in Dallas received $454 million in emergency federal funding before turning over an $815 million surplus in 2020—$20 million higher than in 2019. Meanwhile, the University of Pittsburgh Medical Center received $460 million in federal bailout funding while increasing their revenue from 2019 to 2020 by $2.5 billion However, hospitals with less favorable patient-payer mix, such as New York-Presbyterian Hospital, posted a nearly $500 million deficit in 2020, despite almost $1 billion in federal relief Clearly, the distribution of CARES Act bailout funds must be restructured to provide more equitable relief. In addition, several major policy changes were instated by the Centers for Medicare and Medicaid Services (CMS) in direct response to COVID-19. The CMS Accelerated and Advanced Payment Program was expanded, allowing qualifying providers access to nearly $34 billion to increase their cash flow during the COVID-19 PHE However, this is a loan program and requires providers to eventually pay back these disbursements. The requirements allowing providers to perform telehealth were also rapidly expanded, as were reimbursement codes for telehealth This included codes for previously uncovered telehealth services, as well as reimbursing telephone-only consultations. Many of these expanded telehealth codes have now been finalized in the 2021 Physician Fee Schedule as permanent additions Unfortunately, few of these measures were
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