AAO COVID-19 survey shows revenue losses for private practices
In a survey conducted by the American Academy of Ophthalmology to determine the effects of the COVID-19 pandemic on practices and their patients, 95% of private ophthalmic practices reported they are seeing 25% or less of their pre-COVID patient volume.
“The revenue losses have been tremendous for ophthalmology. The majority of practices expect to shrink in size in the absence of appropriate federal aid, and a significant number of practices will not be able to resume operations at all,” Michael X. Repka, MD, clinical spokesperson for the AAO, told Healio/OSN.
The AAO launched a series of surveys to understand how U.S. practices have been financially affected and the extent of layoffs. The data will also be presented to Congress to show the effectiveness of aid and how much more help will be needed, Repka said.
The AAO surveyed a random sample of 2,500 members in private practice, with a response rate of 16%. According to the survey, 89% of practice owners have applied for payroll protection. Despite taking advantage of available resources, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act, 73% of respondents reported their practices will be smaller, financially unhealthy or both by the end of 2020. Additionally, 6% of ophthalmologists report they will be forced to stop practicing due to the pandemic.
“But there is also hope. With the condition of receiving the right financial support, we’ve seen many of our members become more confident about the possibility of a successful, timely reopening,” Repka said.
Practice owners are now more optimistic about reopening in May than they were in early April. In a second survey conducted from April 23 to 27, 39% of respondents reported they were optimistic about opening in May, an increase from 25% of respondents in a survey conducted from April 9 to 13.
However, if financial aid falls short of projections, 64% reported their practices would be financially unhealthy. CMS began distributing $30 billion in CARES Act grants in the second week of April and another $20 billion on April 24, with 82% of survey respondents reporting they had received funds.
In the April 23 to 27 survey, 92% of respondents said they have applied or will apply for federal loans, with 43% reporting they would likely be applying to two or more programs.
Eighty-seven percent of respondents in the April 23 to 27 survey have applied or plan to apply to the Paycheck Protection Program, 28% have applied or plan to apply to the Accelerated and Advance Payment Program, and 33% have applied or plan to apply for an Economic Injury Disaster Loan.
However, AAO members have reported difficulties with certain applications. For the 87% of respondents who applied to the Paycheck Protection Program, 56% reported the process was either too cumbersome or the funding for the first round of the program ran out.
“There’s still a lot of work to be done, but we’re looking forward to the day when we can safely resume all eye care procedures. We are getting closer every day,” Repka said. – by Robert Linnehan
Disclosure: Repka reports no relevant financial disclosures.
Perspective
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COVID-19 has disrupted the great majority of health care in the United States, but perhaps its effect on ophthalmology has been among the strongest.
There are three reasons for this:
1. We examine our patients at a slit lamp a foot away from the respiratory tract, placing patient and doctor at risk for transmission.
2. Our patients are older with a greater risk for comorbidities that can make COVID-19 infection more serious.
3. The great majority of our surgery is elective.
The American Academy of Ophthalmology has provided superb leadership with guidelines for managing urgent and emergent patient care, while recommending closing our practices to routine care to slow the pandemic. The AAO recently conducted a survey evaluating the effect of COVID-19 on ophthalmic practices and surgery. The results of the survey show that 81% of practices are doing 10% or less of their pre-COVID surgical volume and are observing local and national guidelines. Telehealth is an option for some patients, but the great majority of patients cannot be converted to telehealth.
The financial health of ophthalmic practices has been severely tested by COVID-19, with anticipation of office closures for 3 to 5 months and 89% of practices applying for payroll protection. Of greater concern is that 73% of practices believe that without federal intervention they will be smaller, financially unhealthy or both when they open again. This is of particular concern, as the fundamentals of ophthalmic care remain with our population aging and requiring more ophthalmic care, while the number of ophthalmologists remains stagnant. In addition, patient throughput will likely decrease with changes to the office check-in procedure and sterilization of all patient contact surfaces between each individual encounter.
The majority of ophthalmologists are optimistic about returning to patient care, but we have concerns about the health of our practices and our ability to meet our patients’ needs with the new restrictions created by COVID-19. This is a challenging time for all of us, and the AAO is providing the leadership we all need.
Perspective
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Today, May 5, is my first day back in clinic seeing routine patients after more than 6 weeks of hiatus due to COVID-19. The clinic is largely empty due to the weak demand for our elective surgical procedures, primarily cataract and refractive surgery. This certainly helps with the required 6 feet of distancing between people, but it sure makes the place look empty. The survey results from the American Academy of Ophthalmology show the extent of the stress and hardship that our practices are enduring. Like all ophthalmologists in the U.S. and beyond, our practice is struggling and will need to permanently change in order to adapt to these new conditions.
For those who perform purely elective surgeries such as cataract, refractive and cosmetic, the economic hit may be particularly hard compared with subspecialties in which care is more urgent, such as retina and glaucoma. Older cataract patients may elect to defer surgery for months or longer out of fear of becoming sick. Refractive and cosmetic patients who pay out of pocket for these services are often younger and healthier, but they may have more issues with personal finance due to loss of employment.
The COVID-19 virus will not likely simply disappear, and we will have to deal with it and use strict precautions for months or even years to come. This means a lower volume of patients for in-person visits, longer time between patients to allow for proper disinfection of exam rooms and equipment, and the use of personal protective gear for both medical personnel and patients. In our surgery centers, similar restrictions will limit the number of surgeries we can do per day. The use of telemedicine is increasing but is still limited when it comes to intraocular conditions.
We are doing what our colleagues are doing: being cautious and safe, putting patient interests first and still giving the best care that we know how. We are also seeing the positives of spending more time with family, having a slower pace and appreciating the beauty of life. There will always be a need for ophthalmology, and we will be ready to fill it.
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