American College of Physicians: Internal Medicine — Doctors for Adults ®

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Group visits can save time, but are they right for you?

From the April ACP Observer, copyright 2004 by the American College of Physicians.

By Carl Cunningham and Jackie Blaser

The traditional office visit has always consisted of one patient, one physician and one exam room. In an increasingly popular trend known as group visits, however, physicians are experimenting with ways to combine patient appointments.

While group visits can save time and boost satisfaction levels, many physicians wonder whether the concept is for them. Will patients want to attend a group visit, and can clinical quality be maintained?

According to John C. Scott, FACP, the answer to those questions is yes.

"Many physicians and administrators are coming to the conclusion that the current paradigm of individual office visits alone is economically insufficient," explained Dr. Scott, associate professor of medicine/geriatrics at the University of Colorado Health Sciences Center in Denver. "There isn't enough money to throw enough physicians at the problems of access and quality."

There are two primary ways to conduct group visits: cooperative health care clinics and drop-in group medical appointments. Both models deliver medical care, not just serve as discussion or support groups.

The cooperative health care clinic (CHCC) has evolved into the model of choice for groups with relatively homogeneous patient groups. The drop-in group medical appointment (DIGMA), by comparison, was designed for groups of relatively diverse patients.

Cooperative health care clinics

Dr. Scott developed cooperative health care clinics (CHCC) in 1991 at Kaiser Permanente.

He noticed that many patients needed the same education and help with lifestyle issues. By gathering them in small groups, he could answer all their questions and meet their special needs, which was economically untenable in individual visits.

The CHCC model typically calls for a group of 15 to 20 patients to meet monthly. Those patients, who have similar medical conditions and problems, make a long-term commitment to meet regularly. Over time, they form a primary support group.

The CHCC model is ideal for patients who are high utilizers of medical services. Appointments typically consist of a brief social period, a patient-education segment, time for the physician or nurse to examine each patient in front of the group, and a question-and-answer period.

After the group visit, patients can meet privately with their physician, or the physician can decide that a private exam is needed.

According to a study conducted by Colorado Kaiser Permanente, the CHCC model decreased visits to the emergency room, reduced hospital admissions and the use of skilled nursing facilities, lowered referrals to specialists, and saved or earned extra money for the practice.

Drop-in group medical appointments

Drop-in group medical appointments (DIGMAs) grew out of the personal experience of Edward B. Noffsinger, PhD, a psychologist at the Kaiser Permanente San Jose Medical Center.

As a patient with a serious illness, he found himself struggling to make appointments and to get information about his condition. He concluded that "there must be a better way" and, in 1996, developed the DIGMA concept, convincing Kaiser Permanente to give it a try.

Unlike the CHCC model, DIGMA appointments are open to most patients in a physician's practice. Despite the "drop-in" name, patients register in advance for the weekly group appointment.

DIGMAs are open to both high and low utilizers of health care. Patients with different diagnoses attend the same meetings whenever they feel the need. Because DIGMAs are usually shorter than CHCCs, running 60 instead of 90 minutes, they generally involve fewer patients, typically 10 to 16 to a group.

Like the CHCC, the DIGMA model has been shown to significantly improve patient satisfaction.

A Kaiser study found that DIGMA appointments were cost-effective when at least 5.2 patients attended each meeting.

At this year's Annual Session in New Orleans, Dr. Scott will present a 90-minute course, "Let Group Visits Revitalize Your Practice," (WSO 015) on Saturday, April 24, from 10:45 a.m. to 12:15 p.m.

The Practice Management Center is also posting additional background and billing information for group visits online.

Carl Cunningham, MBA, is Director of the College's Practice Management Center (PMC). Jackie Blaser is a PMC representative.

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