ABSTRACT
Introduction, Objectives, and/or Purpose: The AVLS Financial Impact of the COVID-19 Pandemic on Vein Practices Survey Part I and II was conducted to assess the direct and indirect financial impact the COVID-19 pandemic has had on vein practices in the United States. This encompasses the initial impact of the pandemic (including mandated practice closures) as well as the long-term affect the pandemic as had on financial revenue, practice expenses and patient volume. The survey included changes that were made to practices as a result of the pandemic and what if any government assistance programs were utilized. The survey also addressed changes in patient demographics as a result of the pandemic including patient age, types of treatments and clinical stage of venous disease at presentation. Methods: The survey was anonymous, all US based AVLS members were invited to participate. Surveys were conducted through SurveyMonkey Inc. (San Mateo, California). AVLS members were notified through email, social media and MAC postings. 93 members completed part I of the survey, open from June 29 to July 31, 2020. As the impact of the pandemic was projected to extend beyond the dates of the first survey, a second was conducted one year later. Part II of the survey was open from February 23 to May 12, 2021. 74 members participated in Part II. 41 participated in both. The state in which the participant's practice is located was asked along with practice setting, size, length the practice has been open and percentage of time dedicated to the treatment of venous and lymphatic disease. Practice types were defined as hospital owned/affiliated, solo practice, owner/partner of multi-physician practice and employed physician of a non-hospital affiliated practice. Questions covered: practice revenue changes, patient volume changes, practice expenses and measures/changes taken to offset losses including government assistance programs. Participants (Part II) were asked if practice revenue had returned to pre-COVID levels. The survey also asked how the participants were handling vaccination of their staff. Results: All practice settings were represented with the largest number of responses from physicians in solo practice, 67% (63) of Part I participants and 81% (60) of Part II participants. The majority of participants reported being in practice for greater than 10 years and having less than 10 non-physician employees prior to the pandemic. A total of 71 (76%) part I participants and 59 (79%) part II participants identified their practice as devoted more than 75% to the treatment of venous and lymphatic disease. Practices from 33 states including the District of Columbia were represented in the survey responses. Participants of Part 1 of the survey were asked to give their best estimate of the negative financial impact of the Covid- 19 pandemic on their practice's revenue since the beginning of the pandemic. 52% reported a 25-50% decrease, 23% reported a less than 25% decrease, 15% reported a 51-75% decrease and 5% reported a greater than 75% decrease. On Part II of the survey conducted approximately 1 year later 53% of participants reported a 25-50% decrease, 23% reported less than 25% decrease, 15% reported 51-75% decrease, 5.4% reported greater than 75% decrease and 4% reported no financial impact. Participants of the Part 1 portion of the survey were asked to give their best estimate of the impact of the Covid-19 pandemic on their practice's patient volume since the beginning of the pandemic. 43.0% reported a 25-50% decrease, 23.7% reported a 51- 75% decrease, 21.5% reported a greater than 75% decrease, 9.7% reported less than 25% decrease and 2.1% reported no impact on patient volume. On the follow-up portion of the survey conducted approximately one year later 48.7% of participants reported a 25-50% decrease, 31.1% reported less than 25% decrease, 12.2% reported 51-75% decrease, 5.4% reported greater than 75% decrease and 2.7% reported no financial impact. 48.4% of respondent's reported less than 10% increase in expenses on Part I of the survey and 34.4% reported less than 25% increase in expenses as a result of the pandemic on part 1 of the survey. On Part II of the survey 59.5% of respondent's reported less than 10% increase in expenses and 32.4% reported a 10-15% increase in expenses as a result of the pandemic. The majority of practices surveyed reported participating in a government assistance program. The most common program participated in was the Paycheck Protection Program followed by the CARES Act Provide Relief Fund, the Medicare Accelerated and Advance Payment Program and the Economic Injury Disaster Loan. 55.4% of survey respondents reported having to temporarily close their practice. 50.0% reported reduced services and 70% reported reduced hours. 2% reported permanent closure of practice and 39.8% reported postponement of planned practice expansion. 50% of survey participants reported their practice temporarily laid off/furloughed employees. 11% reported temporary layoff/furlough of physicians. 15% reported permanent layoff of employees and 3% reported permanent layoff of physicians. 12% reported employee pay cuts and 55% reported physician pay cuts as a result of the pandemic. A small group of participants reported seeking temporary employment elsewhere and 48% reported delay of hiring new staff. Vein practices also saw a change in patient demographics as a result of the pandemic. On Part II of the survey participants were asked if they had seen any of the below listed changes in their patient demographics compared to before the pandemic. 48.9% reported a decrease in the number of patients over the age of 65. 46% reported a decrease in the number of patients with C2 and C3 disease. 23% reported a decrease in the number of patients with C5 and C6 disease. 56.8% of participants reported a decrease in the number of physician referral's and 41.9% reported a decrease in the number of non-physician patient referrals. 62.2% of practices reported a decrease in cosmetic treatments. Only 10.8% of participants reported no change in patient demographics. On part 2 of the survey conducted approximately 1 year after the start of the pandemic participants were asked if their practice revenue had returned to normal pre-COVID levels. Only 14.9% of participants reported that their revenue had returned to normal. 37.8% reported a 25% decrease in revenue, 28.4% reported a 25-50% decrease in revenue and 10.8% reported a greater than 50% decrease in revenue. 8.1% reported increased revenue compared to pre-pandemic times. 89.2% of survey participants reported that they had received or will receive the Covid-19 vaccine. 10.8% reported no to the question. Survey participants were asked if they would be requiring their staff to receive the Covid-19 vaccine. 13.5% reported yes. 14.9% reported no. 71.6% reported they are not requiring employees to receive the vaccine but they will be encouraging them to do so. Conclusions: The Covid-19 pandemic has had a significant negative financial impact on vein practices in the United States. The negative financial impact of the pandemic has endured for over a year. This decrease in revenue corresponds to a decrease in patient volume. At one year after the start of the pandemic the vast majority of practices surveyed have not returned to a normal practice revenue level. Both the decrease in patient volume and decrease in practice revenue was surveyed to be greater earlier in the pandemic (Part I) This is likely secondary to mandated closures which were more common earlier in the pandemic and thus better captured by the first survey. Most practices participated in some form of government financial assistance and many participated in multiple. Most practices reported an increase in practice expenses related to the Covid-19 pandemic. As a result of the of the pandemic practices have seen changes in patient demographics compared to before the pandemic. The most significant change was a decrease in patients over the age of 65. Decreases in C2 and C3 patients was more common than C5 and C6 patients. During the surveyed time, practices saw both a decrease in the number of physician referrals and non-physician referred patients. There was a significant decrease in the number of cosmetic treatments during the time surveyed.