Shared appointments could give patients more time with doctor - AmericaNowNews.com

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Shared appointments could give patients more time with doctor

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According to the National Institutes of Health, most patients only see their physician for about five minutes during their entire doctor's office visit.

With health care changes and increased demand for care, some physicians say this amount of time is likely to decrease.

What if you could have 90 minutes of face-to-face time with your doctor, and what if your next appointment wasn't in a clinic at all, but more of a classroom setting?

Shared Medical Appointments (SMA) are a relatively new trend in health care, and they could be beneficial for patients.

Diagnosed with congestive heart failure, Denise Sorensen's life depends heavily on her doctor's care. She isn't shy talking in front of others about her mortality.

"I need you to help me live at least 12 more years," Sorensen tells her doctor while a handful of strangers listen during a SMA.

"Everyone in the room is in the same boat," Sorensen said. "We all have the same condition. We all want to learn as much as we can about it."

SMAs typically group 10 to 15 patients who suffer from the same ailment, usually a chronic condition like diabetes or asthma.

One by one, their mutual doctor catches up, checks up, and counsels each patient.

Dr. Sanjeev Gulati is an Advanced Heart Failure and Transplant Cardiologist for Carolinas HealthCare System in Charlotte.  

Unlike his typical workday where patient visits are scheduled back to back, SMAs give Gulati an hour and a half with the patients he needs, and he can spend more time with them.

"That bond becomes closer because both of us are relaxed, and I don't have one hand on the door because I'm trying to get out – I have four other people to see and I'm 10 minutes behind," Dr. Gulati said.

SMAs allow physicians to see and bill for more patients versus traditional office visits.

This improves hospital productivity, expands access to care, and gives patients what they're paying for – more time with their doctor.

"They come into a shared medical appointment feeling guarded – not ready to reveal a lot of information – but after everybody gets past that first patient, you see great patient interaction and that's something the provider cannot provide in an individual one-on-one setting," said Jim Havlik, Director of Shared Medical Appointments at Carolinas HealthCare System.

The patients who participate in a SMA are volunteers, and they are required to sign a confidentiality agreement.

"Essentially, we go by the model, what's said in the group visit, stays in the group visit just like in Las Vegas," Havlik said.

Many patients, like Sorensen, are dealing with serious health issues and they say being around other survivors provides a source of support.

"They're at their 6 months, and I'm at my two years, and I can see how much I've progressed from where they are to where I am now," Sorensen said.

Often, these patients will hear questions they didn't think about asking as well as answers they might not have gotten otherwise.

If the doctor does not have all the answers, they are able to benefit from the experience and advice of other patients.

"I think that's why they take that advice so seriously," Dr. Gulati said.

Patients say, perhaps, the only downside is getting doctor's orders and having an audience there holding you accountable.

Shared appointments are not intended to replace regular individual visits, treat urgent needs, or treat complex issues.

For now, SMAs require a regular co-pay and are charged to your insurance company just like a traditional office visit.

Copyright 2013 America Now. All rights reserved.

Additional Information:

The following information is from Jim Havlik, Director of Shared Medical Appointments at Carolinas HealthCare System.

  • CHS has about an 80% return rate to shared appointments, and patients are always given the option to go back to a traditional visit.
  • With the Affordable Care Act coming into place, Havlik said, "We know there will be an influx of patients who do not have insurance now but will have and are going to need access to primary care settings as well as specialty care settings. SMAs are a way for us to be prepared for that."]
  • Private exam rooms are available for doctors to examine patients or discuss personal issues after the meeting.

The following information is from Dr. Sanjeev Gulati, Advanced Heart Failure and Transplant Cardiologist for Carolinas HealthCare System.

  • All SMAs are voluntary.
  • Hospitals may have to restructure their clinics into classrooms to make room for SMAs.
  • In a typical day, Dr. Gulati is rushing between patient rooms giving patients about 10 minutes each (assuming the last person wasn't late). He says SMAs have changed his practice by giving him time with patients to build relationships and administer care. 

The following information is from the Cleveland Clinic (Source: http://my.clevelandclinic.org/patients-visitors/prepare-appointment/shared-medical-appointments.aspx).

  • While an individual appointment typically lasts 15 to 30 minutes, a shared appointment is 90 minutes long.
  • Typically, 10 to 15 patients are seen together.
  • SMAs are particularly valuable to people dealing with chronic conditions like asthma, diabetes and hypertension.
  • SMAs are not designed to replace regular individual visits, be used as a one-time consultation, treat urgent medical needs or diagnose and treat complex issues.
  • SMAs are intended to improve access and alleviate the stress on the nation's health care system.
  • Visits are with the health care provider (physician or nurse practitioner) and an additional staff member as a facilitator (RN, behavioralist, psychologist, etc).
  • SMAs are voluntary.

The following information is from the American Academy of Family Physicians regarding SMAs (Source: http://www.aafp.org/online/en/home/policy/policies/s/sharedmedapptsgrpvisits.html). 

  • The American Academy of Family Physicians (AAFP) believes that group visits are a proven, effective method for enhancing a patient's self care of chronic conditions, increasing patient satisfaction, and improving outcomes. Group visits are one component of the system changes needed for the new model of care.
  • Shared medical appointments should be documented in each participating patient's medical record. That documentation should reflect the individual services provided to each patient as well as the services provided to the group as a whole at each encounter.
  • The AAFP believes physicians who provide and document such appointments should code for the services provided using applicable, existing, evaluation and management (E/M) codes found in Current Procedural Terminology. Third party payers should cover and pay for submitted E/M services for shared medical appointments.

The following information is from an article about SMAs from Managed Care Magazine (Source: http://www.managedcaremag.com/archives/0305/0305.sharedappointments.html).

  • SMA improves access and practice productivity, and may even lower overall costs of care.
  • "Observers" are other patients, spouses, and support persons in the group.
  • In a typical SMA, a physician is joined by a behaviorist (often a psychologist or social worker), and by her own nurse or medical assistant (MA). The physician alternately interacts with individual patients (while the behaviorist facilitates group discussion) and with the entire group. Patients ask questions or share information as they wish.
  • Some physicians report patients offer up more information then they otherwise would in a private setting, due to the supportive environment of a group.
  • The DIGMA model was introduced in 1996 by Edward Noffsinger, PhD, and is one type of SMA. Patients with last-minute needs may go to a session without an appointment.
  • John Scott, MD of Kaiser Permanente Clinic in Hidden Lake, Colo., originated the shared medical appointment concept in 1991.
  • A two-year study funded by the Robert Wood Johnson Foundation showed that patients participating in the cooperative-clinic model stayed independent longer and were more satisfied with their physicians and with their understanding of their medical conditions. Physician satisfaction also increased, while hospitalization and ER use decreased by 12 and 18 percent, respectively. Cooperative-clinic participants were 2.5 times as likely to stay with their physician and with Kaiser.
  • Patients are encouraged when they see others with similar or worse conditions. They are not alone.
  • The pace of care is more relaxed and patients get to see their doctor for 90 minutes instead of 10 or less.
  • The information imparted by the physician and other members of the group helps patients manage their condition and allays anxiety.
  • Physicians are able to see (and bill for) at least three times as many patients in an SMA as they would with traditional office visits in the same amount of time. That productivity increase not only pays for the overhead, but yields net gains in revenue and time.
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