Impact of COVID-19 on Your Practice

Thank you for your valuable participation in our brief survey to ascertain how your practice has been affected. Legislators need specific information about staff reductions, the need for PPE, and telemedicine issues. This data will support efforts to increase assistance to medical practices across the state. In addition, this survey data will be used to develop practice-based educational activities that increase access to and skill with using telemedicine to bolster the number of patient visits and practice revenue.

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* 1. Estimate the percentage decrease in patients you see per week due to the COVID-19 pandemic?

1-10%

11-25%

26-50%

51-75%

76-99%

100%

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* 2. Estimate the percentage decrease in procedures you perform per week due to the COVID-19 pandemic?

1-10%

11-25%

26-50%

51-75%

76-99%

100%

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* 3. Have you or do you plan to close your practice?

Yes, temporarily

Yes, permanently

Not sure at this time

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* 4. Has your practice applied for government-funded assistance for small businesses?

Yes

Unsure

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* 5. Did your practice receive an emergency payment/deposit from CMS?

Yes

Unsure

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* 6. What percentage of patient visits did/are you conducting through telemedicine?

	0%	1-10%	11-25%	26-50%	51-75%	76-99%	100%
Before COVID-19 pandemic	Before COVID-19 pandemic 0%	Before COVID-19 pandemic 1-10%	Before COVID-19 pandemic 11-25%	Before COVID-19 pandemic 26-50%	Before COVID-19 pandemic 51-75%	Before COVID-19 pandemic 76-99%	Before COVID-19 pandemic 100%
During COVID-19 pandemic	During COVID-19 pandemic 0%	During COVID-19 pandemic 1-10%	During COVID-19 pandemic 11-25%	During COVID-19 pandemic 26-50%	During COVID-19 pandemic 51-75%	During COVID-19 pandemic 76-99%	During COVID-19 pandemic 100%

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* 7. What has the overall reaction been from your patients regarding telemedicine visits?

Favorable

Neutral

Unfavorable

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* 8. Rate the level of difficulty your practice has with:

	None	Minimal	Moderate	Difficult	Very difficult
Internet connectivity	Internet connectivity None	Internet connectivity Minimal	Internet connectivity Moderate	Internet connectivity Difficult	Internet connectivity Very difficult
Telemedicine reimbursement	Telemedicine reimbursement None	Telemedicine reimbursement Minimal	Telemedicine reimbursement Moderate	Telemedicine reimbursement Difficult	Telemedicine reimbursement Very difficult

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* 9. For telemedicine visits, what percent of patients are using telephone vs. internet?

	0%	1-10%	11-25%	26-50%	51-75%	76-99%	100%
Telephone	Telephone 0%	Telephone 1-10%	Telephone 11-25%	Telephone 26-50%	Telephone 51-75%	Telephone 76-99%	Telephone 100%
Internet	Internet 0%	Internet 1-10%	Internet 11-25%	Internet 26-50%	Internet 51-75%	Internet 76-99%	Internet 100%

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* 10. At your practice, who uses PPE during operating hours?

Clinical staff

Clerical staff

Patients

1 and 2

1, 2, and 3

1 and 3

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* 11. Estimate the quantities of PPE you currently have available at your practice for staff and patients.

Less a week

1-2 weeks

3-4 weeks

1 month

2 months

>2 months

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* 12. How has the COVID-19 pandemic affected your practice staffing?

	0% reduction	1-10% reduction	11-25% reduction	26-50% reduction	51-75% reduction	76-100% reduction
Clerical staff	Clerical staff 0% reduction	Clerical staff 1-10% reduction	Clerical staff 11-25% reduction	Clerical staff 26-50% reduction	Clerical staff 51-75% reduction	Clerical staff 76-100% reduction
Nursing staff	Nursing staff 0% reduction	Nursing staff 1-10% reduction	Nursing staff 11-25% reduction	Nursing staff 26-50% reduction	Nursing staff 51-75% reduction	Nursing staff 76-100% reduction
NP/PA staff	NP/PA staff 0% reduction	NP/PA staff 1-10% reduction	NP/PA staff 11-25% reduction	NP/PA staff 26-50% reduction	NP/PA staff 51-75% reduction	NP/PA staff 76-100% reduction
Physicians	Physicians 0% reduction	Physicians 1-10% reduction	Physicians 11-25% reduction	Physicians 26-50% reduction	Physicians 51-75% reduction	Physicians 76-100% reduction

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* 13. How concerned are you about the negative long-term effects of the COVID-19 pandemic on your practice?

Not at all

Somewhat

Moderately

Concerned

Very concerned

Extremely concerned

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* 14. How interested are you in learning more about the following aspects of patient management during the COVID-19 pandemic:

	Not at all	Somewhat interested	Interested	Very Interested	Extremely interested
Developing protocols for COVID-19 and other infectious diseases for the outpatient setting	Developing protocols for COVID-19 and other infectious diseases for the outpatient setting Not at all	Developing protocols for COVID-19 and other infectious diseases for the outpatient setting Somewhat interested	Developing protocols for COVID-19 and other infectious diseases for the outpatient setting Interested	Developing protocols for COVID-19 and other infectious diseases for the outpatient setting Very Interested	Developing protocols for COVID-19 and other infectious diseases for the outpatient setting Extremely interested
Evaluating and testing of patients with COVID-19 in the outpatient office	Evaluating and testing of patients with COVID-19 in the outpatient office Not at all	Evaluating and testing of patients with COVID-19 in the outpatient office Somewhat interested	Evaluating and testing of patients with COVID-19 in the outpatient office Interested	Evaluating and testing of patients with COVID-19 in the outpatient office Very Interested	Evaluating and testing of patients with COVID-19 in the outpatient office Extremely interested
Infection control and proper use of PPEs	Infection control and proper use of PPEs Not at all	Infection control and proper use of PPEs Somewhat interested	Infection control and proper use of PPEs Interested	Infection control and proper use of PPEs Very Interested	Infection control and proper use of PPEs Extremely interested
Telemedicine equipment and how to use it	Telemedicine equipment and how to use it Not at all	Telemedicine equipment and how to use it Somewhat interested	Telemedicine equipment and how to use it Interested	Telemedicine equipment and how to use it Very Interested	Telemedicine equipment and how to use it Extremely interested
Telemedicine reimbursement	Telemedicine reimbursement Not at all	Telemedicine reimbursement Somewhat interested	Telemedicine reimbursement Interested	Telemedicine reimbursement Very Interested	Telemedicine reimbursement Extremely interested
State regulations for telemedicine	State regulations for telemedicine Not at all	State regulations for telemedicine Somewhat interested	State regulations for telemedicine Interested	State regulations for telemedicine Very Interested	State regulations for telemedicine Extremely interested
Liability concerns with telemedicine	Liability concerns with telemedicine Not at all	Liability concerns with telemedicine Somewhat interested	Liability concerns with telemedicine Interested	Liability concerns with telemedicine Very Interested	Liability concerns with telemedicine Extremely interested
Special considerations for individuals of color	Special considerations for individuals of color Not at all	Special considerations for individuals of color Somewhat interested	Special considerations for individuals of color Interested	Special considerations for individuals of color Very Interested	Special considerations for individuals of color Extremely interested

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* 15. What are your primary concerns/thoughts about the effects of the COVID-19 pandemic on your practice?

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* 16. What is your specialty?

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* 17. Who owns your practice?

Self/independent group

Hospital-owned group

Corporation

Government

Other (please specify)

Impact of COVID-19 on Your Practice

Question Title

* 1. Estimate the percentage decrease in patients you see per week due to the COVID-19 pandemic?

Question Title

* 2. Estimate the percentage decrease in procedures you perform per week due to the COVID-19 pandemic?

Question Title

* 3. Have you or do you plan to close your practice?

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* 4. Has your practice applied for government-funded assistance for small businesses?

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* 5. Did your practice receive an emergency payment/deposit from CMS?

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* 6. What percentage of patient visits did/are you conducting through telemedicine?

Question Title

* 7. What has the overall reaction been from your patients regarding telemedicine visits?

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* 8. Rate the level of difficulty your practice has with:

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* 9. For telemedicine visits, what percent of patients are using telephone vs. internet?

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* 10. At your practice, who uses PPE during operating hours?

Question Title

* 11. Estimate the quantities of PPE you currently have available at your practice for staff and patients.

Question Title

* 12. How has the COVID-19 pandemic affected your practice staffing?

Question Title

* 13. How concerned are you about the negative long-term effects of the COVID-19 pandemic on your practice?

Question Title

* 14. How interested are you in learning more about the following aspects of patient management during the COVID-19 pandemic:

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* 15. What are your primary concerns/thoughts about the effects of the COVID-19 pandemic on your practice?

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* 16. What is your specialty?

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* 17. Who owns your practice?

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* 18. First Name:

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* 19. Last Name:

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* 20. Please enter your email address to receive survey results and educational content on COVID-19:

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* 21. What state do you practice in?