A "perfect storm" of factors — aging and increasingly obese Baby Boomers, rapid healthcare cost escalation and physician-access problems — have come together to virtually ensure that group medical appointments will only become more prevalent in the U.S. health system.
The appointments, which involve several patients with the same chronic disease simultaneously visiting with doctors, have drawn increasing attention in recent years as hospitals search for ways to combat the challenges associated with cost, quality and access.
But group visits — or as the industry calls them, "shared medical appointments" (SMAs) — are well-trod ground for Dr. Marianne Sumego, director of SMAs with Cleveland Clinic, which has been conducting SMAs for nearly a decade.
"They’re not new," said Sumego, an internist at the Clinic’s family medicine center in suburban Willoughby. "What’s new is investing enough energy to do it right, make it a priority and provide something that’s of great patient value."
The Clinic has been offering SMAs since 2002 and now provides them at four Northeast Ohio locations, including its main campus. SMAs are available for several specialty areas, including diabetes, asthma, osteoporosis and women’s health. They typically involve 10 to 15 patients and last about 90 minutes, according to the Clinic.
"When they get 90 minutes, they’re really taking something away from that appointment they wouldn’t get in [a] traditional visit," Sumego said.
Sumego said the Clinic was exploring adding new SMAs in several medical areas, including pediatrics, preventive cardiology and metabolic syndrome.
Advocates of SMAs point to several advantages that the format offers. Patients can typically obtain shared appointments with doctors more easily than solo visits, so SMAs help solve access problems. Patients suffering from the same disease typically have similar questions and concerns, and can learn best practices for managing the disease from their peers.
From the provider perspective, SMAs allow doctors to avoid giving the same spiel over and over again to individual patients. And since many insurers pay the same for shared appointments as they would for individual meetings, health providers generally make out better financially by virtue of a larger patient volume.
Here’s how the appointments work, according to Sumego: First, a facilitator spends about 20 minutes checking in patients, recording their information like blood pressure and weight, and then discusses with patients how they’ve been feeling, whether they’ve been refilling prescriptions and if they have any questions for the doctor. Next, the doctor comes in, and guided by questions the facilitator has logged, chats with each patient about their individual concerns and conducts a group educational discussion.
If the doctor needs to do a physical examination of a patient, the two leave the room while a nurse or medical assistant leads a discussion with the remaining patients. Finally, each patient leaves with an action plan — a specific list of steps they should take to better manage their chronic conditions.
Patients for whom SMAs wouldn’t be ideal are those who have difficulty hearing, need an interpreter or have a rapidly changing disease, Sumego said.
That the vast majority of patients don’t fall into those categories also suggests that the volume of SMAs will continue to rise across the U.S. in the coming years. Just don’t assume that their advent is anything new.
"It’s easy to see SMAs in the setting of healthcare reform, but it’s important to remember that we’ve been doing them a long time and we see a lot of value in them," Sumego said.
