Preparation
- Secure support of your organization's administration. This goes beyond acquiring your organization's approval. You will also need to obtain an adequate support staff, appropriate meeting facilities, and sufficient funding to create the program's promotional materials.
- Establish the health care team that will smoothly navigate the shared medical appointment sessions. The team must include the physician for these patients, as well as a "champion" that has outstanding skills in leadership and team building. In the DIGMA model, this "champion" will ideally be a behavioral health professional (for example, a psychologist or social worker) with experience in facilitating group meetings. This individual will also handle a large part of the program's planning, development, implementation, and evaluation. Enlist the other key team members based on the model of shared medical appointment and the needs of the group. Each group member must be motivated, well trained, courteous, and empathetic. Team members must also understand the role each member plays, allowing for a productive flow to the session.
- Establish a threshold for the minimum census for meeting. In order to maintain financial productivity, the number of patients seen in the shared medical appointment should justify the costs and effort associated with conducting the visit. This is usually accomplished by setting your census at a level that roughly triples the number of patients you could see in the same amount of time by traditional methods. In other words, if you typically see four patients in two hours, a two-hour group visit should allow you to see approximately twelve patients.
- Recognize that shared medical appointments are not ideal for all patients. They are not appropriate for:
- Initial evaluation.
- One-time consultations.
- Most medical procedures.
- Treatment of acute, infectious illnesses.
- Rapidly evolving medical conditions.
- Customize the shared medical appointment sessions to each physician and his/her patient panel. To determine the shared medical appointment model that is best suited for your practice and patients' needs, consider the target population for the group, the health care team structure, and the frequency of the meetings needed.
- Establish procedures for meeting. The procedures may vary depending on the shared medical appointment model. The physician may invite a patient for a one-time visit or to an established group that meets weekly or monthly. Develop a standard for the group to follow. Also consider that in the DIGMA model the patient isn't necessarily invited to the meeting, but may also just drop in. Let the group members know this still requires the patient to call the office a day in advance to allow time to pull the patient record.
- Identify a comfortable place to meet that has an exam room nearby. The room should have sufficient space for enough chairs to accommodate the group. There should also be adequate equipment and forms available for the physician and health care team to conduct a smooth session. The exam room should only be used for the initial part of the meeting to gather crucial information (vital signs, lab values, etc.) and should be available to patients who need to be seen individually after the group session.
- Realize that there is a focus on mind and body for these visits. The shared medical appointments allow for a therapeutic dynamic to take place. There is a potential for patients to share information with one another that opens discussions of psychosocial issues related to their health.
- Address billing and any other system issues before starting a shared medical appointment program. Because of the rapid changes in reimbursement from managed care organizations and governmental agencies, it is best to thoroughly explore your billing options. Contact your local insurers or contracted entities to identify any potential billing issues and to gain a clear understanding of your reimbursement possibilities.
Group Visits
