key: cord-0948308-t6ggwbtx
authors: Satiani, Bhagwan; Davis, Carolyn A.
title: The Financial and Employment Impact of COVID-19 on Physicians in the United States
date: 2020-09-01
journal: J Vasc Surg
DOI: 10.1016/j.jvs.2020.08.031
sha: 7edfa570366cb34b5e6c5d8c5a60d128302b609c
doc_id: 948308
cord_uid: t6ggwbtx

While the COVID-19 pandemic has created havoc with the U.S healthcare system and physicians, the financial and contractual implications for physicians are now beginning to come to the forefront. Financial assistance from the federal government is mainly going to hospitals, which have borne the brunt of the COVID-19 illness. Some physician groups have or are receiving assistance through a few programs, although the accelerated and advance payments have been suspended. Employed surgeons are now being furloughed, terminated, or persuaded to agree to a significant cut in pay, forego bonuses or take leave without pay as healthcare systems and some physician groups start to feel the consequences of halting elective procedures. Newly hired surgeons may be forced in a few cases to agree to delays in starting their job, new amendments, changes in employment status and other terms for fear of losing their job. We explain some agreement terminology and options available to allow physicians to understand the terms of their employment agreement and make their decisions after consulting with an expert healthcare attorney.

Following the initial two trillion dollars provided for in the CARES Act, the loans were 9 disbursed by the Small Business Administration. In addition, another $484 billion COVID-19 10 bill was passed by Congress on April 23, 2020, which included $380 billion for small businesses. 11 From this amount, $321 billion will be used to replenish the previous PPP. An additional $75 12 billion is intended for hospitals. It is uncertain at this time about the portion of these grants and 13 loans that will aid physicians directly without going through a health system, which may 14 subsidize or cover physician compensation. 15 16 Decline in outpatient visits and procedures 17 The volume of outpatient visits has been reduced significantly since the pandemic started. A 18 report collating 50 million visits representing over 50,000 care givers from February 1, 2020 to 19 April 16, 2020 in many different types of organizations showed a decline of almost 60% and 20 continued slowdown in April. (4) An online survey of 2,533 US adults in the early part of April 21 2020 showed that 72% of them or their physician had delayed care or chosen an alternative plan. reported that visits to ambulatory practices declined 60% as of March 29, 2020 followed by a 10 small rebound. (7) The decline in visits was largest in surgical and procedural practices. Americans or about 16.5 million used tele health for the first time during this crisis and of these 37% 19 sought care for chronic diseases. (9) This aspect provides good news beyond the pandemic and allows 20 vascular specialists to allow closer monitoring of their patients who may be unable to come for face to 21 face visits and thereby avoid preventable incidents. 22

The policy of Medicare to cover virtual visits has been a minor relief for some practices. Large 23 employers of physicians were likely already offering tele-visits, and even those visits have decreased. However, smaller practices who were not familiar with telemedicine may find it 1 difficult to start up information technology and workflows. Outpatient telemedicine programs in 2 Vascular Surgery have been reported to reduce travel time and cost for patients. (10) Interstate 3 licensing restrictions as well as non-compliance with the Health Insurance Portability and 4 Accountability Act (HIPAA) have been eased during this crisis. Income from telemedicine office 5 visits, even when covered at regular office visit rates, will not cover overhead and staff payroll as 6 most practices do not have enough reserves. Many healthcare practices may be specifically designed to avoid layoffs, with options such as 10 applying for funding under the CARES Act, diversifying practice groups, rotating schedules, and 11 having staff (such as medical assistants) work from home. Still, with decreased patient volume at 12 most physician practices, these actions may not be enough, and the practices may need to 13 eventually furlough or lay off staff. (11) Besides surgical specialists cutting their own salaries and If furloughing is not an option, practices may consider terminations. Terminations always carry 7 risk to the practice, and any practice terminating employees should consult with their 8 employment counsel before undertaking such measures. As with a furlough, the practice must 9 review state and federal WARN Act requirements to determine their application to the layoff. plans. (14, 15) Newly hired surgeons who have already signed employment agreements and had 4 planned to start July 1, 2020 may also be dealing with a changing landscape. Employers may 5 also be asking them to delay starting their job and amending their employment agreements if 6 elective surgery volume has not picked up at the institution. be imperative for health systems and physicians as they navigate these unprecedented challenges.

Even if the COVID-19 pandemic in the U.S declines more quickly than initially projected, there 21 is considerable uncertainty about the future for small businesses-including some physicians and 22 small surgical practices as well as for surgeons employed in large groups. Although some states 23 J o u r n a l P r e -p r o o f may now allow elective surgery, it is more than likely that vascular disease patients will still be 1 reluctant to put themselves at risk unless procedures are absolutely needed to relieve pain, to 2 prevent life or limb threatening consequences, or due to personal circumstances. Therefore, until 3 health systems and physician groups catch up with backlogged elective surgery, many surgeons 4 may be faced with temporary downward adjustments in their compensation.

1 for healthcare providers? Available at https://www.pwc.com/us/en/library/covid-2 19/covid-19-consumer-behavior.html. Accessed 5/19/2020. To ensure that local hospitals and health systems have the capacity to absorb and effectively manage potential surges of COVID-19 patients. Also, issued a waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital providing patient care. Medical residents will be allowed more flexibility to provide services under the direction of the teaching physician. In addition to being able to directly supervise a resident with their physical presence during key portions of a procedure, teaching physicians can now also provide supervision virtually using audio/video communication technology. Wider use of verbal orders https://www.cms.gov/newsroom/factsheets/additional-backgroundsweeping-regulatorychanges-help-us-healthcare-system-address-covid-19-patient https://www.cms.gov/newsroom/factsheets/additional-backgroundsweeping-regulatorychanges-help-us-healthcare-system-address-covid-19-patient 

6201 -Families First Coronavirus Response Act

Accessed 4/24/2020)

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