Sharing a room with a dozen other patients to talk to your doc about what can sometimes be intimately personal health issues doesn't seem like an ideal approach, but hospitals are finding that physicians and patients alike have an appetite for such group visits, and other providers should probably be jumping on the bandwagon.
We've all heard plenty about the shortage in primary care, which is only expected to grow worse in the coming years. The Association of American Medical Colleges estimates that there's already a shortfall of about 25,000, which will balloon to 45,000 by 2020 as systems flood with baby boomers and newly insured patients from exchanges. Providers are trying everything to get ahead of the shortfall, from bolstering the ranks of nurse practitioners and physician assistants, to using virtualized clinic visits that don't even need docs.
Another approach that seems to be attracting renewed interest is the shared medical appointment, or SMA. If a swamped physician is spending half of his or her time answering the same questions over and over, or giving the same breakdowns on how to manage a disease, why not find a way to streamline that? Such group visits can bring a dozen or so patients together in the same room to learn about their diseases all at once, and have a more in-depth discussion with their doctor.
Zeev Neuwirth, M.D., is no stranger to the concept. He helped launch 70 different group patient visits — with more than 30 different physicians, in 18 different specialties — during a stint at Harvard Vanguard Medical Associates. Now Neuwirth is introducing the concept to Carolinas Healthcare System in Charlotte, N.C., where he serves as chief medical officer of ambulatory care and corporate health services. Carolinas has five or so SMAs going on right now, with plans to start 10 or more in the near future. The results thus far have been pretty spectacular. Nearly 100 percent of patients said they had enough time with their provider, did not feel rushed, were satisfied with the quality of care they received, and benefited from being with other patients in the group visit. One doctor in rheumatology — a scarce specialty with long wait times — was able to see almost twice as many patients in a week with just one 90-minute group visit a week. The average wait time for the doc's third available appointment was cut in half, down to 80 days.
But one of the biggest pluses of the program, says Neuwirth, and what first attracted him to the model, is allowing patients with the same conditions to interact with one another. Sometimes those with chronic conditions can feel lonely, isolated and as if they're never going to turn a corner with their disease.
"This becomes a big part of your life, and no one else really understands what you're going through except someone else who is going through it," Neuwirth says. "The opportunity to have other people around, just like you, who are dealing with similar things goes a long way, not only in the experience of care, but also actually in the quality of care."
So what are the drawbacks and limitations of such a model? Probably not everyone wants to sit through a 90-minute appointment, and some just might not be able to get past their misconceptions about the format. The Cleveland Clinic, which has been perfecting its SMA strategy for the past decade or so, points out that they shouldn't be used to diagnose and treat complex medical care, or replace regular individual visits with a physician. Doctors, too, might have some angst about speaking in front of a group, but Edward Noffsinger, an industry expert on the topic, writes that most doctor concerns are anxiety-based and often melt away once they try one out.
The model requires a scribe, which can be hard to afford in a regular practice, but it can easily pay for one with its increased productivity, Neuwirth says. Getting reimbursed for an SMA is no problem either, as they're coded and paid for just like an individual visit, and doctors don't take credit for doing something across the group itself.
"You could do a medical appointment out in the middle of the street and code for it," Neuwirth says. "It doesn't matter that there are cars going by or people are watching, you're still doing a medical visit, as long as you document it accurately."
What's your hospital's experience been like with shared medical appointments? Share your thoughts in the comment section below, and watch for my story on the topic in the May issue of H&HN.