Skip to Main Content

By Nicolas Mouawad, MD, MPH, MBA, FSVS, FRCS, FACS, RPVI

The COVID-19 pandemic has rapidly, profoundly, and likely irreversibly, changed health care delivery in the United States and around the world. Everyday items that a surgeon once took for granted such as masks, gloves and gowns are now coveted assets, carefully set aside in the corner of my office. I try to make do with what I have.

We hope that, with time, things will somehow get better. Instead, it is about to get worse.

On August 4th, the Centers for Medicare & Medicaid Services announced a rule that would cut payments for vascular surgeons seeing Medicare patients by 8% starting in January 2021. Other surgeons will see even higher percentage cuts. These changes will lead to reduced access to care and increased wait times for patients to get care.

But time is tissue.

This phrase is a bedrock concept in the field of vascular surgery. As a vascular surgeon, I have dedicated my career to fixing blockages in the blood vessels—to preventing strokes, heart attacks, gangrene, amputations, and ultimately, to prevent disability and death.

The overwhelming majority of my patients are Medicare beneficiaries, as vascular disease disproportionately affects the elderly. These patients can’t wait. They couldn’t wait before COVID-19. And they can’t afford to wait even longer due to these Medicare payment cuts. Congress needs to prevent this from happening by waiving budget neutrality for the Medicare rule change.

Every day I see what it means when vascular patients are forced to wait. I see disease I could have fixed if they were seen sooner but now gangrene set in and amputation is the only option. Or that they waited too long and sustained a stroke requiring long term care, nursing and assistance. Again, time is tissue.

There is no doubt about the financial strain that the pandemic has caused to our health system. Our hospitals nationwide are losing $1.4 billion a day due to decreased revenue caused by the pandemic, with outpatient surgery volumes dropping by 71%. A nationwide survey of private practice surgeons found that one-in-three was planning on closing their doors due to financial pressures of the pandemic, even before these cuts were announced.

We are adapting to this new environment and it will be this way for a while. I assure you. And if these Medicare payment cuts go into effect on January 1, we are going to be stuck in an even deeper hole than the one we’re in now. More surgeons will be forced to shut their practices and more hospitals won’t be able to afford to operate.  That is why Congress needs to act now, waive budget neutrality, and protect America’s health care workers and Medicare patients.

I went into medicine to care for patients. I want to take care of my patients. They need access to quality care and they can’t wait for it. Time is tissue.

Read more about the effort to stop Medicare Payment cuts at

Dr. Nicolas Mouawad is chief of vascular surgery at McLaren Health System – Bay Region in Bay City, Michigan and is affiliated with multiple medical facilities in the area, including McLaren Bay Region, McLaren Thumb Region, McLaren West Branch and McLaren Caro that focus on medically underserved areas and underserved populations. He is an active member of the American College of Surgeons and the Society for Vascular Surgery.