If strapped-for-time doctors are spending half their appointments repeating themselves, why not just gather a handful of patients in the same room so they can hear it all at once?
Grappling with a primary care shortage that's only expected to worsen, hospitals are testing shared medical appointments to ease the burden. 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 physician.
The Cleveland Clinic has been perfecting its approach over the past decade, but refocused on SMAs a couple of years ago as the landscape started to shift, says Marianne Sumego, M.D., director of shared medical appointments. Doctors have expanded from just five different SMAs to more than 30, by developing a standardized approach to starting new ones without having to hit reset.
Sumego believes that the 90-minute, on average, group visits make sense for health systems looking to improve efficiencies and better use scarce resources. But she stresses that SMAs aren't just about stuffing patients into a room to increase access; each is still an individual visit in a group setting.
"This is still a medical appointment. This is not being done for reasons that are simply access-driven," Sumego says. "We have been conducting SMAs long before anticipated changes in health care, because we see them as quality visits and want to offer them to our patients."
Convincing doctors of that sometimes can require a physician champion, especially in large health systems, says Edward Noffsinger, an expert in group visits who helped Cleveland Clinic develop its approach. Some physicians may have angst about speaking in front of groups or violating confidentiality agreements, but most fears melt away once they dive in.
While the model requires a scribe, affording one becomes much easier for smaller hospitals or clinics because of the increased output. Noffsinger estimates that, by tripling a doctor's productivity during one 90-minute block of the week, he can increase his productivity for the entire week by about 9 percent.
"It's on everybody's short list of innovations that they know they need to try," Noffsinger says. "And with the Affordable Care Act coming into play, group visits have so much to offer that they will continue to grow substantially in future years."
Carolinas HealthCare System in Charlotte, N.C., is jumping into the fray, with five SMAs running and plans to start 10 more, says Zeev Neuwirth, M.D., chief medical officer of ambulatory care and corporate health services. The results so far have been eye-opening: 100 percent of patients said they had enough time with their provider, did not feel rushed, were satisfied with the quality of care and benefited from being with other patients.
But one of the biggest pluses of the program for Neuwirth, and what first attracted him to the model, is allowing patients with the same conditions to interact with one another. "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.