They can enhance patient access, they have the potential to lower costs, and they’re likely here to stay. Group visits are on the rise as health care professionals seek to engage patients as partners through new and innovative care-delivery models. Such visits bring together groups of patients with similar medical needs for shared education, counseling, and one-on-one evaluations with a physician.
To date, group medical appointments have been most used by patients who are managing chronic illness, including diabetes, asthma, heart disease, and cancer. But the support-group atmosphere can also benefit smokers, patients with HIV, and those battling eating disorders, anxiety, or even menopause. “Group visits are definitely catching on as they become more billable,” says Susan Childs, a practice management consultant with Evolution Healthcare Consulting in Durham, North Carolina. “Efforts like the patient-centered medical home have also encouraged their adoption.”
Indeed, a growing number of third-party payers, including Medicare and private insurers, reimburse for shared medical appointments as they would a regular visit because the clinician documents the encounter in each participating patient’s medical record. “The whole goal for the insurance industry is positive outcomes, and those can be enhanced by peer support,” says Childs. “Peer support, in turn, is enhanced by group visits. It’s a win-win-win.”
According to the American Academy of Family Physicians (AAFP), group visits have been linked to better patient adherence, increased patient satisfaction, fewer emergency room visits, and improved quality of life. Because patients spend more time with their doctors in group visits—and time gaining emotional support from each other—they have also been shown to enhance patient loyalty.
Edward Shahady, a Florida-based family doctor who teaches other physicians how to implement group visits, says shared appointments are particularly useful in treating patients who have difficulty achieving goals. “It’s a supportive environment in which someone might ask a question, and I’ll ask if anyone else in the group has had that problem,” he says. “Another patient might say, 'Yes, I have,' and we’ll discuss what they did about it and whether it worked. It gives the patient confidence to see that the other patient is now better. It also lets them know they are not alone.”
Group visits are most efficient—and equally effective—when a medical assistant or nurse practitioner hosts the first hour, addressing basic questions, administering injections (if needed), and reviewing lab results privately with each individual, says Shahady, who notes that his role is to address more complex medical questions, provide recommendations, and moderate group discussions.
The frequency with which you assemble group visits should be based on the needs of your patients, but the AAFP suggests scheduling visits at least every 6 to 8 weeks to effectively monitor patients with poorly controlled type 2 diabetes or other chronic conditions. That also allows providers to keep tabs on physical activity and eating behaviors and provide positive reinforcement to enhance motivation. Medicare and some private payers will allow up to 9 paid group visits for diabetes self-management training in one calendar year, the AAFP reports.
Although waiting rooms can double as group-visit meeting locations if needed, keep in mind that such an approach typically requires staff to stay after hours, which costs your practice money. Converting the break room into usable, revenue-generating space is the better bet by far, says Shahady.
Because group visits are interactive and personal experiences and advice are shared, every effort must be made to ensure that personal health information is protected, says Childs. “This needs to be addressed,” she says. “The physician needs to explain to every patient attending group visits that they must agree to keep confidential anything they hear in the group.” Better yet, Childs suggests having each patient sign a confidentiality agreement as a condition of participation, which should be kept in the medical record. To encourage confidentiality, physicians might also provide examples of what information is appropriate to share in a group setting, and what should be discussed in an individual visit.
If you’re considering implementing group visits in your practice, be prepared to market them. A sign in the lobby or pop-up on your patient portal won’t be sufficient to generate interest, says Shahady. “You have to invite them personally,” he advises. “Tell them, ‘Look, our approach isn’t working, and we are both frustrated. Do you want to come to a group visit to see if that might work better?’” Over the last 11 years, says Shahady, 90% of his patients who tried it once returned at least a second time.