Doctors are faced with many challenges on a daily basis, and, naturally, one of those is the simple fact that there are only so many hours in the day in which to fit those challenges. Physicians are pressured to see more patients per hour in an industry that rewards efficiency and speed, while still needing to find a way to educate their patients about complex diseases and chronic illnesses, which can be difficult to do in 15 minute increments.
While education is often best delivered in one-on-one personal engagements, common sense and practice has shown us that learning is most efficiently accomplished in group settings, such as what our children receive in their classrooms, or in the crowded lecture halls in colleges across the nation.
In a group setting, an educator can address a group that shares the same learning goals, whether they be academic or practical. Many doctors are now using “group visits” to achieve similar goals with patients who share the same chronic condition, such as diabetes or heart disease. In the article “How Group Visits can Improve Chronic Condition Management,” as reported by Medical Economics, Marianna Sumego, MD, says, “In today’s healthcare environment, it’s challenging to simultaneously maintain access, engage patients, and improve quality of care. Group visits can help us address all three of those challenges.”
According to the article “Group Visits 101,” published in the AAFP, there are a few reasons why many doctors are adopting “group visits” as part of the practice’s offerings. Group visits are thought to help increase physician productivity and decrease the practice’s cost per visit. They can provide a break from traditional office visits, where doctors find themselves repeating the same advice and information to patients with shared medical conditions. Group visits can reduce backlogs in schedules that are typically clogged with low-acuity recheck appointments. And perhaps most importantly, they can provide improved care for patients with chronic conditions, and can lead to an increase in both patient satisfaction and compliance.
The AAFP article cites two studies that show that group-visit patients had fewer ER visits, visits to subspecialists, hospital admissions, and made fewer phone calls to doctors, while having an overall higher satisfaction rating with their care.
Anecdotal evidence suggests the same: patients thrive in groups. Sumego continues, “There’s value in patients encouraging each other that we as physicians are not able to capture when we see them one-on-one…one of the main benefits of shared medical appointments is to leverage the value of shared experiences among peers.”
But be warned, there are challenges to implementing group visits in your arsenal of care.
Probably the most critical challenge is remaining HIPAA compliant in the group setting, with many physicians opting to have their group-visit patients sign confidentiality agreements and HIPAA disclosure forms, confirming that their participation in the group setting is voluntary and promising to keep all information confidential. Doctors will also have to make sure they can get reimbursed for group-visits which can be tricky from a billing perspective. In addition, coordinating a group of patients can be a logistical hurdle, and may lead to frustration if patients are required to wait on other members of the group, not to mention the task of having an adequate workspace where the group feels comfortable.
As reported by Medical Economics, Dennis Saver, MD, part of a 12-physician group practice, says, “You need a setting where you can host a group and there’s a lot of prep work involved on the front end. But once it’s up and running, it becomes easier to keep it going.”
Saver, who hosts group-visits in his employee lunchroom, says, “Your team is critical and should be included in developing the workflow and the implementation plan from the beginning. Talk with everyone about what it will take to check in 12 patients at once.”
He also reminds us that it’s essential to identify someone within the practice—whether it’s a physician or another clinical staff member—who can act as a facilitator. This person should have the skills to lead and direct interactive group discussions. “Group visits are not meant to be lectures,” he notes, “The process should be fun and useful and encourage patients to share their personal experiences and insights with others.”
Of course, we once again get back to the issue of HIPAA and patient privacy, so any physician choosing to go down this path should discuss their plan-of-action with their lawyer and insurance company to make sure they are HIPAA compliant.
So what might one of these “group-visits” look like?
Medical Economics suggests that group visits typically include around a dozen patients who share the same chronic condition, such as weight loss or diabetes. A group visit will typically start the same as a normal office appointment, with clinicians taking vitals and adjusting medications in private, and then moving on to group presentations that will be relevant to the group. These presentations could be a forum for discussion on disease-related topics, or they could be more about fostering social interaction between patients, and the formation of support groups for patients with similar ailments.
The same article also gives a nice “best practice” list, which should give any doctor a good starting point.
As a final statistic to mull, in 2006, the AAFP cited a study by The Future of Family Medicine Project that suggested that group visits have the potential of generating an additional $15,411 per physician per year, while enabling patients to interact with, learn from, and encourage one another. They also reduce the redundancies that family physicians face in one-on-one sessions in which they have to essentially explain the same concept to similar patients. The work on the front-end to get group visits up and running appears to be fairly time-intensive, though it ultimately may be able to help physicians generate more income, deliver higher patient satisfaction, save physicians time, and most importantly, lead to better outcomes for patients.
- Involve your Team. Explain the concept to your staff and asses how it will affect office workflow. Explain the benefits of group visits, what you hope to accomplish as a team, as well as the challenges you may face.
- Think through the Logistics. For instance, in a 2 hour group visit, you will need to use part of that time to check in patients, take vitals, adjust medications, and the like. Overall satisfaction will increase both with your patients and employees by having a concise schedule with no surprises or unplanned wait times.
- Determine the appropriate size. This is as much determined by the size of where you wish to hold the group-visit as it is by the nature of the topic. The number of patients in the group setting should be small enough to manage but large enough that it makes sense from a financial perspective
- Invite guest speakers. Once your group is rolling and meeting regularly, keep patient interest levels high by inviting other perspectives to the group.
- Don’t do it alone. It’s very difficult to lead a group, take notes, update charts, and conduct individual patient check-ups. In addition, it would be wise to discuss your plan with another trusted associate who has already implemented group visits or has been associated with the process in some way. Similarly, to make sure that you aren’t violating HIPAA, it would be wise to discuss any group-visit program with your attorney and insurance carrier.
