Friday, August 09, 2013

Marketing Shared Patient Appointments

As health care reform kicks in to high gear, a new innovation in health care delivery is being touted at Cleveland Clinic: shared patient appointments. On the surface, this idea seems so efficient and social as patients with similar medical problems sit around in a group therapy session that masquerades as health care. After all, with the large influx of new patients to our health care system underway and the limited health care personnel resources available, the push for such a model was inevitable.

But many Americans are also noticing another disturbing trend: higher insurance premiums to offset the cost of those who do not have sufficient resources to pay for their care.  While the reality of our higher health care costs demand that the added costs be paid by someone, I suspect most of those who will be paying higher premiums didn't think they'd have to "share" their physician appointments with others. 

But here we are.

For large health care systems, shared patient appointments offer the promise of high revenue streams with low overhead costs.  As such, there is no downside to promoting such a model:
Since 2005, the percentage of practices offering group visits has doubled, from 6% to 13% in 2010. With major provisions of the Affordable Care Act due to be implemented by next year, such group visits are also becoming attractive cost savers — patients who learn more about ways to prevent more serious disease can avoid expensive treatments. (ed's note: Sales pitch - there are no data that group appointments "prevent" more serious disease or "avoid" expensive treatments)

“It’s a different way of speaking about health that is more about friends around a circle learning together than talking with an authority figure in a white coat,” says Dr. Jeff Cain, president of the American Academy of Family Physicians, in describing shared medical appointments. Think of them as a blend between group therapy and support groups. The net effect is the same – a sense of comfort, support and even motivation that comes from sharing similar experiences. (ed's note: Easy for him to say.  Any proof?)
Looking at this, how could anyone argue?  It seems like such a helpful premise.  But patients subjected to such a system have to agree one very important issue: surrendering their privacy:

But they do require divulging and discussing private medical information in front of strangers (albeit ones who have signed waivers not to talk about other patients’ medical histories outside of the visit).
We should ask ourselves: how will assurances of patient privacy in such a setting be enforced?  If another patient discusses a participant's health care needs and concerns outside of such a meeting, will that person be reprimanded?  If so, how?  And what extent must HIPAA privacy laws be waved as a result of this model?  
These are only a few of the concerns for patients.  We should also ask what the outcomes are for such a model?  What value to patient's get for their health care dollar if another member of the group is more vocal and insists on speaking while others have to remain mute?  Will they be guaranteed an opportunity to have their question(s) addressed?  And how will patient's be selected for participation in these groups?  Will diagnosis codes be used?  If so, what happens (psychologically) to a group of early diabetics who are placed in a group with a diabetic with more extensive disease?  Might there be negative repercussions when a young diabetic sits with a diabetic amputee or renal patient?  
Efficient health care delivery models are needed going forward, but attempts at social re-engineering that can alienate some patients in favor of others and stands to profit a system rather than the individual demands careful evaluation before marketing such a model as gospel to our health care system.



Lisa said...

I can't even fathom what an appointment like that would look like. Using their diabetic model, after having my blood drawn and A1c checked, I go into a room with other diabetics to have the meters downloaded to discuss what is going on? Seriously? With my A1c of 5.0 I'm supposed to listen to a bunch of people discussing what was going on when they hit that string of 300's for a week, when what I really need to be talking about is how to prevent the morning lows that I wake up with occasionally and maintain a healthy A1c? Do I really need a lecture on carb counting? That dog don't hunt!

Anonymous said...

This is easy, I refuse. What a terrible idea. I wonder if the people marketing this will have appts. like this, yeah didn't think so!

Anonymous said...

This is what happens when we allow lawyers and MBA's to take over healthcare! It's our own fault for just assuming they had everyone's best interests in mind as they came into health care management and we couldn't be bothered to comment.

Anonymous said...

This model occurred years ago in education and is still gospel. The teacher is the guide on the side not the sage on the stage. Students were to be placed in small groups within the classroom and teach each other. As one high achiever said to me, " When a project is assigned, I do the work and the others sit around sniffing the magic markers." This classroom model was also promoted as a way to ensure " cooperative learning".
So now we get to go into cooperative learning mode during our medical appointments? We already have a laptop between the patient and the doctor, who rarely glances up to actually SEE the patient. And now he/she will be so far removed from the equation, why even bother to make an appointment. Let's all just meet at Panera's.

Anonymous said...

Group Visits: A Qualitative Review of Current Research
Raja Jaber, MD, Amy Braksmajer, MPH and Jeffrey S. Trilling, MD

Improving Primary Care for Patients With Chronic Illness:

The Chronic Care Model, Part 2
Thomas Bodenheimer, MD; Edward H. Wagner, MD, MPH; Kevin Grumbach, MD
JAMA. 2002;288(15):1909-1914. doi:10.1001/jama.288.15.1909.

Wall Street Journal, Dec 19 2012 Group Healing

More data than for most things medical

Do you think Cleveland Clinic would stake reputation on this lousy idea without some data/evidence/experience?

Kaiser has done alot wtih this.

Good friend of mine does alot.. great results. group visits for DM and for the socially marginalized/psych patients whom Northshore docs fight over...

Anonymous said...

Group visits in psych are very common and often better outcomes.

Anonymous said...

Wow Dr. Wes has become quite the pessimist! Any change is automatically seen as a terrible idea.

Sure, group visits are not for everyone, nor for every condition. But have you ever sat in on a ICD support group? Many of these patients love having the chance to meet people with similar problems and often they learn a lot. Lots of times patients don't even know the right question to ask!

Relax. This might be a great option for some people.


Michelle said...

I have atrial flutter and the only other person I know that has it told me she didn't want to know anything about her condition. I couldn't believe it.

I want to know as much as I can so I know how to deal with it. Not wanting put my head in the sand. I would welcome the idea of talking to other patients who deal with A-Fib or A-flutter.

SeaSpray said...

Hi Dr Wes - Do you have any posts on nuclear Stress tests?

Thank you.

SeaSpray :)

Anonymous said...

Group colonoscopies and pelvics!

Anonymous said...

"And how will patient's be selected for participation in these groups?"

Well, that's easy: you choose those patients whose lives are so empty and meaningless that they'll gladly take a three hour appointment over a 15 minute one.