Impact of COVID-19 on Your Practice Survey

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* 1. How many FTE providers in your practice?

Less than 10

10-50

51-100

More than 100

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* 2. Describe your practice location

Urban/Suburban

Rural

Both

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* 3. If both, what percentage of providers practice in rural areas?

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* 4. Estimate the percentage decrease in office visits in your practice since the onset of the COVID-19 pandemic?

1-10%

11-25%

26-50%

51-75%

76-99%

100%

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* 5. Estimate the percentage decrease in medical 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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* 6. How has your practice revenue been impacted since the beginning of pandemic?

Dramatically decreased

Significantly decreased

Slightly decreased

No change

Slightly increased

Significantly increased

Dramatically increased

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

Yes, temporarily

Yes, permanantly

Not sure at this time

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* 8. Has your practice received financial assistance from government-funded assistance programs?

Yes

Planning to apply

Unsure

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* 9. What percentage of patient visits have you conducted via telemedicine…

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

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* 10. Overall what has been the perception of the use of telemedicine in your practice?

Favorable

Neutral

Unfavorable

Not currently using but interested

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

	Yes	No	Varies
Clinical staff	Clinical staff Yes	Clinical staff No	Clinical staff Varies
Clerical staff	Clerical staff Yes	Clerical staff No	Clerical staff Varies
Patients	Patients Yes	Patients No	Patients Varies

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

3 days or less

4-7 days

8-15 days

3-4 weeks

1 month+

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* 13. Do you have a consistent supply chain for getting PPE if you were to open on May 1?

	Yes	No
PPE	PPE Yes	PPE No
Masks	Masks Yes	Masks No
Gloves	Gloves Yes	Gloves No
Gowns/covers	Gowns/covers Yes	Gowns/covers No
Swabs	Swabs Yes	Swabs No
Disinfecting supplies	Disinfecting supplies Yes	Disinfecting supplies No

Other (please specify)

Question Title

* 14. What staffing modifications have you made due to Covid-related financial challenges?

	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

Question Title

* 15. Overall, how concerned are you about the negative long-term effects of the COVID-19 pandemic on your practice?

No concerns

Somewhat concerned

Moderately concerned

Very concerned

Extremely concerned

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

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* 17. Is your practice primary care?

Yes

Multispecialty

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* 18. Practice ownership - my practice is ....

Private practice, physician owned

Hospital or health system owned

Corporation owned

University affiliated

Government entity

Other (please specify)

Impact of COVID-19 on Your Practice

Question Title

* 1. How many FTE providers in your practice?

Question Title

* 2. Describe your practice location

Question Title

* 3. If both, what percentage of providers practice in rural areas?

Question Title

* 4. Estimate the percentage decrease in office visits in your practice since the onset of the COVID-19 pandemic?

Question Title

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

Question Title

* 6. How has your practice revenue been impacted since the beginning of pandemic?

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

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* 8. Has your practice received financial assistance from government-funded assistance programs?

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* 9. What percentage of patient visits have you conducted via telemedicine…

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* 10. Overall what has been the perception of the use of telemedicine in your practice?

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

Question Title

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

Question Title

* 13. Do you have a consistent supply chain for getting PPE if you were to open on May 1?

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* 14. What staffing modifications have you made due to Covid-related financial challenges?

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* 15. Overall, how concerned are you about the negative long-term effects of the COVID-19 pandemic on your practice?

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

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* 17. Is your practice primary care?

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* 18. Practice ownership - my practice is ....

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* 19. Name

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* 20. Practice name

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* 21. Please provide your e-mail address

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