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?

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

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* 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?

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

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* 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:

  None Minimal Moderate Difficult Very difficult
Internet connectivity
Telemedicine reimbursement

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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
Internet

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

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

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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
Nursing staff
NP/PA staff
Physicians

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

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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
Evaluating and testing of patients with COVID-19 in the outpatient office
Infection control and proper use of PPEs
Telemedicine equipment and how to use it
Telemedicine reimbursement
State regulations for telemedicine
Liability concerns with telemedicine
Special considerations for individuals of color

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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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* 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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