Financial Health of Private Equity-Backed Ophthalmology and Optometry Groups: an Analysis of Debt Valuations (preprint)

Purpose To identify debt valuations of ophthalmology and optometry private equity-backed group (OPEG) practices, which are a proxy for financial performance. Design Retrospective cohort study using the 2021 Business Development Company (BDC) Report and BDC quarterly/annual filings. Participants BDCs holding one or more ophthalmology/optometry group debt instruments. Methods The 2021 BDC Report was used to identify all BDCs actively filing annual reports (Form 10-Ks) and quarterly reports (Form 10-Qs) in 2021. The public filings of BDCs lending to OPEGs were searched from inception of an OPEG’s debt instrument in a BDC’s portfolio, and the amortized cost and fair value of each debt instrument were tabulated. A panel linear regression was used to evaluate temporal changes in debt valuations. Main Outcome Measures Trends in total debt held by OPEGs, trends in valuation (premium or discount) of OPEGs. Results A total of 2997 practice locations affiliated with 14 unique OPEGs and 17 BDCs were identified in 2021. Debt valuations of OPEGs decreased 0.46% per quarter over the study period (95% CI: −0.88 to −0.03, P = 0.036). In the COVID-19 pre-vaccine period (March 2020 – December 2020), there was an excess (additional) 4.93% decrease in debt valuations (95% CI: − 8.63 to −1.24, P = 0.010) when compared to prepandemic debt valuations (March 2017 – December 2019). Effects of COVID-19 on valuations stabilized during the pandemic post-vaccine period (February 2021 – March 2022), with no change in excess debt valuation compared to pre-pandemic baseline (0.60, 95% CI: −4.59 to 5.78, P = 0.822). There was an increase in practices that reported average discounted debt valuations from 20 practices (1.6%) associated with 1 OPEG to 1213 practices (40.5%) (including 100% of newly acquired practices) associated with 9 OPEGs, despite stabilization of COVID-19 related excess (additional) debt. Conclusions Valuations of OPEG debt have declined significantly post-PE investment from March 2017 to March 2022. An excess (additional) decline in valuations was observed during the COVID pre-vaccine period, with trends in excess debt valuations returning to baseline pre-pandemic levels by December 2021. Declining and discounted valuations of debt raise concerns about the financial viability of many PE-backed practices.

Population-scale Longitudinal Mapping of COVID-19 Symptoms, Behavior, and Testing Identifies Contributors to Continued Disease Spread in the United States (preprint)

Despite social distancing and shelter-in-place policies, COVID-19 continues to spread in the United States. A lack of timely information about factors influencing COVID-19 spread and testing has hampered agile responses to the pandemic. We developed How We Feel, an extensible web and mobile application that aggregates self-reported survey responses, to fill gaps in the collection of COVID-19-related data. How We Feel collects longitudinal and geographically localized information on users' health, behavior, and demographics. Here we report results from over 500,000 users in the United States from April 2, 2020 to May 12, 2020. We show that self- reported surveys can be used to build predictive models of COVID-19 test results, which may aid in identification of likely COVID-19 positive individuals. We find evidence among our users for asymptomatic or presymptomatic presentation, as well as for household and community exposure, occupation, and demographics being strong risk factors for COVID-19. We further reveal factors for which users have been SARS-CoV-2 PCR tested, as well as the temporal dynamics of self- reported symptoms and self-isolation behavior in positive and negative users. These results highlight the utility of collecting a diverse set of symptomatic, demographic, and behavioral self- reported data to fight the COVID-19 pandemic.