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mirrored by private insurers and the growing levels of unemployment have drastically increased the uninsured population Provider reimbursement remains overall negatively affected by the COVID-19 PHE. CMS further acknowledged the impact of the COVID-19 pandemic in their proposed updates for the Quality Payment Program for 2021 This year's proposed rule addressed the need for more gradual implementation of changes that were previously mandated as part of the Medicare Access and CHIP Reauthorization Act. Reporting of performance measures was also adjusted as an acknowledgment of the disruption in care from the COVID-19 PHE. However, performance thresholds were still increased and the weight of performance categories shifted; specifically, the cost performance category's weight was increased These changes were meaningful, as failure to meet thresholds can result in a reimbursement deduction for underperforming providers despite COVID-19. Added to this, the initial CMS proposed rule for the 2021 Physician Fee Schedule included a deduction of the conversion factor by >10% to maintain budget neutrality for the increased evaluation and management codes implemented during the COVID-19 PHE This would have resulted in a disproportionate impact on procedural providers due to reduced relative value unit–based reimbursement. Through extensive political efforts, this proposed action was mitigated by the Consolidated Appropriations Act of 2021 via an additional transfer of funds into the CMS budget, reducing the cut to 3.3% However, surgical specialties remain vulnerable in the federal response to the COVID-19 PHE as we attempt to recover from this crisis. The greatest financial losses sustained were in the first 4 months of the COVID-19 PHE Encouragingly, many markers of health care productivity have returned to prepandemic levels. One major hospital's vascular surgery division found that their margins returned to within 1% of pre-COVID levels by month 4 of the PHE However, to regain financial equipoise will still require ongoing efforts to counter those losses. Increased productivity to recover these losses has been encouraged. One group estimated that a 10% increase in productivity would require 15 to 16 months to recover the financial losses from the first 3 months of the pandemic With a more realistic increased productivity of 5%, this would still require 31 to 32 months A separate financial modeling study of an academic university vascular surgery practice determined that increasing revenue by 10%, 5%, or 3% above prepandemic levels would lead to recovery of pandemic-associated losses by 9 months, 19 months, or 31 months, respectively However, these estimates do not consider the burden on providers to sustain this level of productivity, as well as their preexisting fatigue from providing health care through a national emergency. In addition to taking care of others, COVID-19 has taken a personal toll on vascular surgeons, as assessed by a global survey by Shalhub et al More than 1,600 vascular surgeons globally responded anonymously to the Pandemic Practice, Anxiety, Coping and Support Survey for Vascular Surgeons disseminated and amplified over several platforms. More than 50% of the respondents reported some degree of anxiety, and just under one-quarter reported moderate or severe anxiety. Factors associated with increased self-reported anxiety levels included staying in a separate room at home or staying at the hospital or a hotel after work, donning and doffing PPE, financial concerns, and worrying about potential adverse patient outcomes due to care in delay Added to this is the mounting pressure to address the surgical backlog created by the COVID-19 PHE As surgical services recover and expand in an attempt to address this backlog and recover financial losses, consideration must be given to creating transparent algorithms for patient prioritization, increased surgical capacity through utilization of outpatient care, and increased perioperative efficiency while maintaining safe COVID-19 operating protocols Ongoing advocacy efforts for continued aid for the health care workforce remain critical, as the path to financial recovery is clearly