Clinical, financial and academic implications of COVID-19 on a tertiary care interventional endoscopy programme.

While there is consensus that the COVID-19 pandemic has negatively impacted delivery of routine clinical care and has put enormous stress on the financial status of healthcare systems, definitive data on the effect of this ongoing pandemic on individual subspecialties, such as interventional endoscopy, are lacking. In an audit, we projected a 7.3% decline in the annual procedural volume, 15.2% increase in anticipated procedure-related reimbursement and 22.6% loss in downstream revenue to the health system, per Medicare fee structure calculations. While lack of patient enrolment delayed conclusion of clinical trials, educational activities transitioned from inperson to online attendance with greater outreach and more delegate participation. Some changes, particularly pertaining to patient referrals and education, are likely permanent. The healthcare system has not experienced a pandemic crisis in several generations. When healthcare delivery is severely disrupted, screening and diagnostic evaluations can often be delayed without adversely affecting long-term health. However, for interventional endoscopy centres, where referrals are often for diagnosis of suspected malignancies or for minimally invasive treatment such as resection of early cancer, delay in medical care carries consequences. While an estimated 18 million GI endoscopic procedures are performed each year, before and after undergoing procedures, patients often require additional work-up that includes hospitalisations, diagnostic investigations and oncological or surgical treatment. These evaluations and interventions generate both direct and indirect downstream revenue for health systems.1 While it is widely believed that healthcare institutions face unprecedented clinical workflow and financial pressures due to COVID-19,2 its impact on the discipline of interventional endoscopy is unclear. Our objective was to examine the clinical, financial and academic implications of COVID-19 on a tertiary-level interventional endoscopy centre in the USA. The Center for Interventional Endoscopy, instituted in the AdventHealth Orlando hospital in April 2013, is staffed by 5 full-time endoscopists and 62 support personnel …