Group Medical Visits Are Catching On
by Stefani Daniels, Managing Partner, Phoenix Medical Management, Inc.
Published on Apr 26, 2016
Kaiser Permanente and Cleveland Clinic began offering group appointments about a decade ago. They found that participants who attend monthly group visits end up with fewer ER visits and hospitalizations.
The return of global payments (the new terminology for capitation) and the uptick of new beneficiares added to insurer rolls, drop-in group medical appointments (DIGMA) have re-surged as a strategy for gaining efficiencies, patient support, and improving access. Originally introduced by Edward Noffsinger, a health psychologist and former Director of clinical access improvement for the Palo Alto Medical Foundation, the DIGMA concept is a potent strategy to diminish waits for medical visits, especially for patients recently released from the hospital.
Dr Noffsinger came up with the idea when he was seriously ill with pulmonary hypertension and had to wait 3 months for a 15 minute office visit. Then he had to wait an hour and a half to actually see the doctor. The visit was so rushed that he forgot to ask some important questions. Dr Noffsinger found the entire experience not only frustrating but isolating. Noffsinger spoke with some Kaiser physicians who agreed to test the group visit concept. It seemed like a natural for many specialists since they were repeating the same information over and over with patients sharing the same medical condition. In addition, it was reported that many patients had problems complying with their therapeutic regimen and the Kaiser physicians knew that other patients could help.
The model that was developed proved immediately successful and leveraged a primary care physician's time by at least 300%. Meetings last about 60-90 minutes and sometimes include spouses and family members. Between 12 and 22 patients participate and most groups are disease-specific. In some DIGMA models physicians work with a behavorial health professional to address psychosocial issues such as quality of life. In other models a care coordinator participates to identify patients who may need more robust follow-up between visits. One innovative program opened in Wheat Ridge, Colorado designed specifically for geriatric patients. The doctors and nurses in the practice found that the conversations among patients did more to improve their lives than any physician lecture. The patients are dealing with similar issues and often help each other.
Another unique use of shared medical appointments was created by Dr Britt Smith, a family physician in Olympia, Washington. Dr Smith found that by grouping patients who requested a visit to treat obesity, he was able to monitor the patients more closely and provide a comprehensive approach to weight management that emphasized lifestyle modfication over drug intervention. His patients took hold of the idea and now they invite experts in nutrition, exercise and behavior modifcation to keep their motivation high. As a result of the success of the obesity program, Dr Smith now holds group appointments for his patients with diabetes.
The process for the these group visits vary but seem to follow a consistent schedule:
- As each patient arrives for the group appointment, their vitals are taken and recorded on each patients chart (paper or EMR).
- A physician provides education and advice relevant to the disease or condition common to the group.
- The 'guest speaker' provides additional information and answer questions. Guest speakers vary and may include a nurse specialist, a care coordinator, counselor, pharmacist, nutritionist or physical therapist.
- At the end of the session, the physician may see individual patients when medically necessary.
While the benefits for patients may be clear, reimbursement by payers for these group visits are not. If physicians are receiving bundled or capitated payments its not generally an issue but if not, the office manager should contact their payers to determine the correct codes.
Not all physicians are suited to group situations and feel more comfortable in a one-on-one relationship. But for those harried doctors who feel comfortable working with groups, especially patients with chronic conditions, it may be a life-saver.