AMA Reports a Crash in Physician Revenues, Visits Over Summer

Ken Terry

October 30, 2020

Physician practices nationwide lost 32% of their revenue, on average, from February through the summer, according to a new American Medical Association (AMA) survey of 3500 physicians, conducted from mid-July through August. That period coincided with the second wave of the coronavirus pandemic in the United States.

A third of practices reported a revenue drop of 25% to 49%; 15% said their volume had fallen by 50% to 74%, and 4% saw a decrease of 75% or more.

Because of the pandemic, 81% of physicians were providing fewer in-person visits than in February. In-person visits dropped by 50% or more for more than one third of physicians. The average number of in-person visits fell from 95 to 57 per week.

Physicians who responded to the survey held an average of six weekly telehealth visits before the pandemic, 29 at the height of the pandemic in the spring, and 16 the week they were surveyed. Twenty percent of respondents with any telehealth visits had conducted them before the pandemic; 77%, at the height of the crisis; and 68%, in the survey week.

Among the doctors who weren't involved in telehealth visits before the pandemic, only 23% conducted them at the pandemic's peak; 12% conducted them in the survey week.

Despite the telehealth increase, almost 70% of physicians were providing fewer total visits, including in-person and virtual encounters, than before the pandemic, the survey shows. Twenty-one percent saw a decrease of 25% to 49%; 11%, a drop of 50% to 74%; and 10%, a falloff of at least 75%. On average, total visits fell from 101 to 72 per week.

Other Surveys More Upbeat

A larger survey by Harvard University, the Commonwealth Fund, and the technology company Phreesia found that total outpatient visits in early October had rebounded to the level of March 1. This was a major turnaround from late March, when visits had plunged by nearly 60%.

According to the Harvard/Commonwealth Fund's ongoing survey, visits started recovering in late June, although they were still off by 10%. They began rising further around Labor Day. The AMA researchers began conducting their survey in mid-June. The summertime surge in COVID-19 likely accounted for their finding that practice revenues were off by a third from the February baseline.

If so, the return to normalcy early this month may not represent the current situation as the virus sweeps across the country for a third time. In any case, even if patient visits and revenues have recovered more than the AMA data indicate, most practices will not have recovered from their losses earlier in the year.

A third survey more closely mirrors the AMA results. At the end of June, according to data from the Medical Group Management Association, revenues for the association's members were 76% of what they had been in June 2019, and patient volume was 78% of that in the previous year.

Practice Expenses Rise

The AMA survey also found that since February, practice spending on personal protective equipment (PPE) had increased by 57% or more, on average. Sixty-four percent of practice owners said their PPE expenditures were up from what they had been before the pandemic. For nearly 40% of practice owners, this expense had increased by 50% or more.

Thirty-six percent of the respondents said that acquiring PPE was very or extremely difficult. This was an especially big challenge for smaller practices, which do not have the purchasing power to compete with big healthcare systems for masks, gowns, and gloves, the AMA noted.

Forty-one percent of doctors in practices with one to five physicians said they had difficulty getting PPE, compared with 30% of those in practices of 50 or more doctors. Only 25% of respondents in practices owned by hospitals and health systems said this was a problem.

Acquiring sufficient PPE is just one factor in the increase in practice expenses attributable to COVID-19. Still, it is indicative of the financial woes affecting physicians during the pandemic.

Nearly all respondents agreed that federal financial relief early in the pandemic was helpful and was appreciated. Among these programs was the CARES Act, which authorized the Provider Relief Fund, which accepted applications through August 28; the Medicare Accelerated and Advance Payment Program, which was suspended in April; and the SBA Paycheck Protection Program, which ended on August 8.

To date, Congress had not approved the renewal of any these programs.

"Physician practices continue to be under significant financial stress due to reductions in patient volume and revenue, in addition to higher expenses for supplies that are scarce for some physicians," said AMA President Susan R. Bailey, MD, in a news release on the survey's findings. "More economic relief is needed now from Congress as some medical practices contemplate the brink of viability, particularly smaller practices that are facing a difficult road to recovery."

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