05.04.20

AAO Surveys Reveal Severe Effect COVID-19 Is Having on Ophthalmology Practices

Source: American Academy of Ophthalmology

The American Academy of Ophthalmology (AAO) released the initial findings of a series of COVID-19 pulse surveys, which aim to reveal the pandemic’s effect on ophthalmology practices and their patients. The pulse surveys will be used to advocate for additional relief and to develop resources to help members and their practices survive in a post-COVID world.

The first survey focused on private practices. Surveyed practices are adhering to public health and the Academy’s recommendation for only providing urgent and emergent care: 95% of the practices are seeing 25% or less of their pre-COVID patient volume, and 81% are seeing 10% or less of their pre-COVID surgical volume, according to the survey results.

Members believe that the majority of their pre-COVID patient volume will not be billable as telemedicine services: 37% indicated none of their patient volume can be handled through telemedicine and be billable; and 61% indicated 10% or less of their patient volume can be converted to telemedicine and be billable.

Practices anticipate being closed 3 to 5 months and have concerns about when and how they will be able to resume patient care.

They are taking advantage of available resources, including through the CARES (Coronavirus Aid, Relief and Economic Security) Act, with 89% applying for payroll protection.

A concerning result from the survey is that a majority of members project that without substantive federal grants and loans that their practices will be smaller, financially unhealthy or both by the end of the year.

  • 47% will be smaller and financially unhealthy
  • 26% will return to pre-COVID size and volume, but financially unhealthy
  • 14% will be smaller, but financially healthy
  • 6% will no longer practice ophthalmology
  • 2% of practices will be sold
  • Only 6% believe that they will be back to pre-COVID size, volume and financial health.

The Academy is fighting for additional financial relief from the government and drug companies and developing resources to support practices through this pandemic.

To conduct the study, the Academy surveyed a randomized sample of 2,500 members in private practice from April 9 -13, 2020. The response rate was 16%, and results have a confidence interval of 95% +/-4% margin of error.

Ophthalmologists: Optimistic About Opening Soon, But Worried About State of Practices

Practices are more optimistic about opening sooner, but more concerned about the size of their practices and their financial state when they do reopen, according to responses to the Academy’s second COVID-19 member pulse survey.

In a survey conducted April 23-27, more than a third of respondents (39%) said they expect their practices to reopen in May. When asked that question two weeks earlier, only 25% were that optimistic.

The Academy already has been publishing resources to help members navigate the reopening process.

A recent Commonwealth Fund report showed ophthalmology to be the practice hardest hit in terms of decline in outpatient visits during the coronavirus pandemic. That’s why federal relief is so important to your practices, why you’re concerned about the adequacy of that aid and why Academy staff is pushing lawmakers in Washington, D.C., to provide you enough relief that you can provide the quality care that your patients expect and deserve:

  • Two weeks ago, 61% of Academy pulse survey respondents said that in the absence of substantive federal grants or loans, their practices would return smaller than they were before. Now, 78% of respondents tell us their practices will be smaller if they don’t get enough support. However, fewer respondents now predict they will no longer practice ophthalmology.
  • The latest survey reinforces how important federal aid is to ophthalmic practices. Nearly two-thirds, 64%, say that whatever size the practice is upon return, they fear their practice will be unhealthy financially without adequate federal aid. The earlier survey showed that 73% thought they would be financially unhealthy, with fewer practices having received any aid at that point.

The Academy surveyed a randomized sample of 2,500 members in private practice from April 23-27, 2020. The response rate was 15%, and results have a confidence interval of 95% +/-5% margin of error. Additional surveys will be fielded to understand the changing effects of this pandemic on ophthalmology.

Federal Aid Is Arriving, But Ophthalmology Practices Need More Help

More ophthalmology practices have received federal aid now compared with early April. However, some face hurdles, and some are still waiting for their support, according to the Academy’s latest COVID-19 member pulse survey.

That federal aid is critical so that practices can keep employees on the payroll and appropriately treat patients who need urgent care today. It is critical help as practices prepare to ramp up to deliver non-urgent care as states reopen, messages the Academy is delivering to federal lawmakers.

We surveyed members from April 23-27, a follow-up to a similar survey conducted April 9-13.

Asked about the federal CARES Act programs that sent relief grants to providers based on 2019 Medicare revenues, 82 percent of respondents said they had received the funds. CMS began distributing $30 billion in the second week of April and another $20 billion on April 24.

While practices did not have to apply for those grants, the federal loan programs do require applications. During the second survey window, 92 percent of respondents said they have or will apply for those loans. 43 percent said they plan to apply for two or more programs.

Under the Paycheck Protection Program, practices are further along in the process now than they were two weeks ago. 58% percent now tell us that they have completed their application compared with 11 percent in the earlier survey. Of the group that has completed applications, 68 percent now report that they have received funding.

However, some members are frustrated with the process. Among survey respondents who applied for the Paycheck Protection Program, 56 percent said they experienced difficulties. The top two challenges were that the process was cumbersome (27 percent) and that funding ran out (14 percent). The Academy has been sharing these experiences with the House and Senate Small Business Committees and was pleased to see Congress act to replenish this program.

A federal loan program, the Medicare Advance Payment initiative, has been much less helpful. Only 28 percent of respondents said they have or will apply for that program, which the government suspended on Monday. The program is risky because of practices’ uncertain future patient volume, as the period to repay the full amount of the advanced payment without penalty is short, with the remaining balance treated as loan at an unattractive interest rate.

The Academy surveyed a randomized sample of 2,500 members in private practice from April 23-27, 2020. The response rate was 15%, and results have a confidence interval of 95% +/-5% margin of error. Additional surveys will be fielded to understand the changing effects of this pandemic on ophthalmology.

 

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