Healthcare associations face steep revenue declines as meetings go virtual

It's been well established that COVID-19 pummeled the finances of healthcare providers. What's been less discussed: It did a similar number on the associations that support those providers.

Hosting massive, in-person conferences that draw hundreds or thousands of people is one of the main ways groups like the American Hospital Association, the American College of Healthcare Executives and the Medical Group Management Association make money. While they've quickly pivoted to online gatherings, a virtual conference draws just a fraction of the revenue of an in-person event.

"It's crushing to not have these events," said Andrew Swanson, MGMA's vice president of industry insights.

A recent survey of almost 900 association leaders found that 34% of healthcare associations expect to lose $500,000 or more each due to events being canceled because of COVID-19, compared with 21% for all other industries, according to the American Society of Association Executives.

The Radiological Society of North America on Tuesday canceled the in-person version of its annual conference, slated to begin in late November in Chicago. That's a big deal for an organization that draws 45% of its total revenue from the annual scientific assembly, according to its tax form for the year ended June 30, 2019. RSNA has canceled the physical meeting only twice in its history—1943 and 1945—due to transportation and gasoline supply shortages during and after World War II. The annual event attracts close to 52,000 attendees.

"We are currently evaluating the financial implications of transitioning to an all-virtual meeting, recognizing that there are both adverse revenue implications and cost savings associated with this decision," Mark Watson, the group's executive director, said in a statement. "However, health and safety remain our primary consideration."

For MGMA, virtual conferences generate just 20% of the revenue of in-person conferences. That's because admissions fees are roughly half what they would be otherwise—sometimes less—and there's almost no revenue from sponsors, who would otherwise pay for booths in an exhibitor hall, Swanson said.

There's also the question of whether health systems and other providers will cut ties with associations as they look to trim their ever-growing expenses. Some association leaders say they're already giving members more leeway when their dues come up for renewal, although none signaled plans to lower the prices of their memberships. Some healthcare associations have already struggled with steep declines in dues revenue in recent years.

Maybe it's not surprising, then, that associations are following in the footsteps of their provider clients in questioning whether to lay off or furlough employees or tap into their reserves to stay afloat.

One bright spot: Healthcare associations appear to be less reliant on reserves than their counterparts in other industries. The ASAE survey found 42% of healthcare associations plan to use less than 10% of their reserves during the pandemic. Across all other industries, that was 23%. Among healthcare associations, 22% said they don't expect to have to go into their reserves at all, compared with 19% across all other industries.

"We all have reserves for a reason, and this is the rainy day," said Susan Robertson, ASAE's CEO. "But you work really hard to build reserves for the future and it doesn't feel good to use them. Overall, healthcare organizations are faring pretty well there."

Deborah Bowen, CEO of the American College of Healthcare Executives, said her organization's board hasn't decided yet whether to use its reserves. That organization was among the first to decide to call off a major in-person conference that had been scheduled for late March in Chicago. Education, which includes conferences, comprises about 40% of ACHE's revenue, Bowen said.

"There's no doubt that's a blow," she added.

Some associations say they've been churning out webinars and other online education for their members who are in the trenches of treating COVID-19 patients and struggling with canceled procedures. Much of it has been free so far, but depending on how long the pandemic lasts, association leaders say they'll need to find a way to charge for them.

"My gosh, for us, we're busier than ever," said Joe Fifer, CEO of the Healthcare Financial Management Association. "We're trying to reconstruct everything and deliver it in different ways."

HFMA had to cancel the live version of its annual conference, which was scheduled for late June. That was a "big deal" for the association, Fifer said. Instead, HFMA, which typically derives roughly one-third of its revenue from conferences, will deliver the content virtually over a three-month period. Members will be able to access the content for free under HFMA's all-inclusive membership model.

"It won't be the same as the exhibit hall and all that activity, but it's the next best thing," Fifer said. "We're trying to make lemonade out of lemons here."

More than half of the roughly 450 registrants for HFMA's annual conference opted to receive refunds for their tickets, Fifer said. Others applied the money to next year's conference or turned it into multiple years' worth of membership dues.

The Healthcare Information and Management Systems Society has taken heat from would-be exhibitors and sponsors for refusing to offer refunds after the organization canceled its annual trade show days before it was slated to start in March. Instead, HIMSS is offering partial credit toward its annual events in 2021 and 2022. Conferences comprised almost half of HIMSS' revenue in its fiscal 2018. HIMSS declined to comment.

MGMA so far doesn't plan to cancel the live version of its annual conference in San Antonio in October, but the team is closely monitoring government rules around large gatherings, Swanson said.

"We're nervous," he added.

MGMA's annual conference typically draws around 3,000 attendees plus 1,000 exhibitors, partners and sponsors. Obviously, this year's event will be much smaller, he said, noting that it will be a "hybrid," with enhanced virtual offerings for people who don't want to attend in person. For example, instead of virtual attendees watching speakers from a livestream, presenters will pre-record their sessions for the virtual audience and participate in a live question and answer session with virtual attendees.

"With the face-to-face conference, you can catch the speaker after and have a physical, one-on-one chat with them," Swanson said. "With that opportunity not being present, we're trying to do something different to bring that same exposure of attendee to speaker."

MGMA already moved conferences scheduled for April and May online, and found that those who attended were a "totally different crew" than those who had planned to attend in person, Swanson said. The association gave refunds to people who were signed up to attend those events in person.

The upside of virtual conferences is organizations can potentially draw a much larger audience than they would to an in-person event. That's because those who don't have the money or time to attend the in-person conference might watch online instead. With health systems cutting travel budgets and executives scrambling to manage the COVID-19 crisis, that could be a lot of people.

"An association might have had 2,000 people attend its in-person conferences, and 6,000 attend its virtual ones," said Amy Ledoux, ASAE's chief learning and meetings officer. "There is an opportunity for virtual to be quite profitable for organizations because of the engagement of more people. You're able to reach more people that might not have had the money for travel and things of that sort."

Education programs such as conferences were the AHA's second largest revenue category behind dues, having drawn about 18% of its total revenue in 2018, the latest year for which tax information is available. Michelle Hood, the AHA's chief operating officer, said in a statement that the association is transitioning several key 2020 meetings and conferences to virtual events and will continue to grow its revenue sources beyond live events.

The American Medical Association's major meetings are dedicated to policymaking and don't draw revenue from exhibitors, registration or commercial advertising, spokesman R.J. Mills wrote in an email. The next such meeting was planned for June and will be held virtually.

ACHE is still learning how to deliver a valuable experience virtually, and what to charge for that, Bowen said.

"I think we're recognizing that this is simply a year that we're going to prioritize service and value to members over what we're going to gain in revenues," she said. "How that balances out at the end of the year, I don't know."