Key Takeaways from AAO 2026 — What Practices Told Us

AI scribes were the most talked-about product at nearly every booth, ours included. Practices arrived with sharper questions than they had a year ago: how accurate are the notes, how much cleanup do they need, and where do the tools still fall short? Our team heard that AI is not yet where practices want it for chart review and claims processing. Interest is also expanding beyond documentation into billing, and automated handling of insurance denials came up frequently.

Research supports the scrutiny. A real-world pilot published in JMIR Medical Informatics in 2026 reviewed 356 AI-drafted notes from 31 physicians. It found that 94.7 percent were free of significant errors. Still, omissions were the most frequent error type, appearing in 18 percent of notes. In addition, 5.3 percent contained an error that could cause serious harm if left uncorrected. As a result, the authors concluded that clinician review of every note remains essential. A September 2026 review in BMJ Digital Health & AI adds ambient scribes as general-purpose tools and that performance varies widely across clinical settings. That is why vendor choice and specialty fit matter. Neither study is specific to ophthalmology.

In our conversations with practices, physicians also want assurance that an AI-drafted note will not repeat the same language from visit to visit, as this can raise audit concerns. The safeguard is a note that reflects the specific encounter, which means the physician reviews and edits every draft before signing.  

Practices who stopped by our booth told us other AI scribes they had seen struggled with accuracy. One team member spoke with a longtime client, who was looking at general dictation software before learning what Optivate’s AI features could already do for his documentation.

Practices evaluating these tools can start by asking each vendor for accuracy data. They should also ask how the vendor trained the model. Our guide on what to look for in an AI documentation partner lays out a full set of criteria.

Declining reimbursement and a rising cost of doing business came up in conversation after conversation, and practices are planning around both. The numbers support the concern. The AMA’s analysis of the 2026 Medicare fee schedule found that 54 percent of ophthalmologists face a payment cut, and the 2026 payment increase enacted by Congress is temporary. The American Academy of Ophthalmology reports that CMS estimates an over 4 percent cut to ophthalmology Medicare payments in 2027 under the proposed rule. The main driver is that increase expiring at the end of this year.

That context helps explain why revenue cycle management came up so often as a way to protect margin. It also explains the caution. Several practices described bad experiences with RCM vendors in the past. As a result, any vendor offering billing services has to keep proving it will do things differently.

Private equity came up repeatedly. Independent practice owners described weighing rising costs against the operational relief a larger group can offer. Practices that had already decided, whether to stay independent or partner with an investor, spoke about it with conviction.

That fits the market. Private equity-backed ophthalmology groups continue to change hands, with strategic acquirers buying PE-backed platforms in ophthalmology and other specialties. The practices at AAO were describing a decision many of their peers are in the middle of making.

Operationally, whichever direction a practice goes, systems that scale across locations and reporting structures matter more than they did two years ago. A workflow that holds up at one location and breaks at three becomes a liability during a transition.

Practices have no shortage of point solutions, and many of those tools don’t talk to each other. It was one of the most consistent complaints our team heard, and it came up without prompting. One team member summed it up this way: clients have plenty of integration pieces available to them, yet those pieces don’t interface or co-work with other programs. It is the same pattern behind why disconnected workflows are the #1 complaint among ophthalmologists, and hearing it independently at the booth reinforced it.

Many visitors stopped by with a question about the EMR or needed something shown in the practice management system. That was a useful reminder of how many layers a platform like Optivate’s has. It also showed how often a practice’s real pain point sits at the handoff between those layers. Ease of use plays a part too. Each extra click or screen switch is another small handoff, which helps explain the growing interest our team heard in cleaner interfaces and fewer clicks in the EHR.

Feature comparisons came up in nearly every booth conversation. Still, the strongest signal on the floor was about trust, responsiveness, and the experience of working with a vendor’s team. One team member put it directly: a high level of customer service means more to a practice than what the software alone can offer. Industry research points the same direction. KLAS’s 2024 ophthalmology report found respondents of all sizes describing a declining vendor relationship alongside issues like bugs and product stagnation. In contrast, coverage of the 2026 Best in KLAS awards credited the most improved vendors’ gains to better customer partnership and proactive communication.

Practices described support from their current software companies as one of their most common frustrations. The skepticism runs deepest around revenue cycle management, where past bad experiences are still fresh. Vendors have to demonstrate trust, because reassurance alone moves no one.

Relationships built over the past year also showed their value in New Orleans. Clients who work with our team stopped by more than once over the three days, and our team noticed that familiarity and name recognition carried real weight with them. One team member described the show as a chance to help practices find the right solution instead of simply pitching a product. Hearing existing clients speak also made clear how developed those relationships are.

For practices evaluating vendors, the lesson applies on any show floor. Ask who will be on your account team, how the vendor handles support requests, and what existing customers say a year after go-live. Our pre-show guide to the top questions to ask every EHR vendor at AAO 2026 covers these in more detail.

The themes from AAO 2026 point in one direction. Reimbursement pressure is real. Consolidation is an active decision for many practices. AI documentation is facing more legitimate question about accuracy. And frustration with systems that do not integrate is growing as practices add more point solutions to their tech stacks.

These trends also connect to each other. A practice under reimbursement pressure is more likely to consider private equity. A practice considering private equity needs systems that scale across locations. And a practice managing either path has little patience for tools that do not talk to each other. It has just as little patience for an AI tool that needs constant double-checking.