When Cleveland Clinic NP Marianne D. Harris, MS, CNP, steps into the provider role during her postdischarge cardiac surgery group, she checks pain meds, answers questions about wound care, and soothes worried caregivers. But her favorite part of running a group medical appointment comes at the end, when the patients talk among themselves about their recent bypass or valve replacement.
“It’s very affirming for them to know they’re not alone in dealing with these issues,” Harris says. “They’re getting medical management, but they’re also getting a sense of support from other patients.”
Different Skill Set
Harris has been running group appointments since 2002. Over time, this unique format has grown in popularity. At Cleveland Clinic, patient satisfaction with group appointments is about 85%.
Group appointments seem to be most effective for patients with chronic diseases, such as diabetes or congestive heart failure, says Dee Ann K. Schmucker, MSW, LCSW. Schmucker, a Sacramento, California, consultant who helps medical facilities streamline their group appointment programs, wrote a book on the topic, Group Medical Appointments: An Introduction for Health Professionals (published by Jones and Bartlett).
Schmucker says NPs and PAs are particularly suited to running group appointments because they are well trained in patient education and work well in a team. Sheldon Weiss, MD, an internist in Rockford, Illinois, acknowledges that not everyone is cut out for group appointments. For the past six years, Weiss has offered eight different groups for nearly 300 diabetes patients in his practice.
Weiss decided to try it after learning about group appointments during an Institute for Healthcare Improvement conference. He has tried to persuade some of his physician colleagues to try it, but they didn’t like it.
“It does require a different skill set—it’s facilitating and educating and being able to manage group dynamics,” Weiss explains. “I’ve noticed a lot of physicians are reluctant to step out of their usual pattern.”
How It Works
Anyone who is able to prescribe medication can run a group medical appointment, Cleveland Clinic’s Harris says. In her case, the group appointment is billed as a bundled charge, but many clinicians can bill for it directly and receive about 85% of a physician’s fee (depending on the state).
As for privacy, at Cleveland Clinic, patients must sign a HIPAA form before the group meeting, agreeing to participate in a forum in which private information will be shared among patients. Harris also asks patients to agree to keep confidential what happens during the group appointments and not to discuss them outside the office.
Both Weiss and Harris begin the group appointment by doing a short physical exam, checking vitals, looking for wound infections, and adjusting medication. While the providers are busy with the exam, the facilitator (usually an RN) chats with the other patients and jots down their concerns.
Then, the group comes together with eight to 10 patients in a big circle. Usually, Weiss opens with a certain topic for discussion: a new medication on the market or something diabetes-related that has made the news. He keeps it brief, then opens the floor to questions. The facilitator makes sure the conversation flows smoothly and finds a way to tactfully redirect any patients who are going off topic or dominating the discussion.
Like Harris, Weiss enjoys watching the patients interact. “They seem to get to know each other, and they get comfortable talking in front of each other,” Weiss says. Often, they feel other patients have more credibility because they have been through the same thing. The patients keep each other honest and inspire one another. “Some of them have even started meeting to exercise together,” he says.
Start Your Own
These group appointment experts offered some general pointers to clinicians who might be new to the process. First, they all said it was important to have a scheduling staff that is flexible and excited about the program. They will be instrumental in recruiting patients to join the group appointments.
At Weiss’ office, they schedule the groups for a Saturday. He says to just block off a few hours, set a time, and go for it. If you make time for it, the patients will come.
If one patient drops out of the group, Weiss adds, it’s important to recruit a new one right away so the group stays full and does not gradually disband.
Harris said it’s also important to avoid treating a group appointment like medical school lecture time. If you let the patients do the talking about certain health issues you want to highlight, the group members will pay more attention than they would if a health professional gets up there and drones on for an hour.
The ideal group member is someone who is learning to live with a chronic condition but hasn’t mastered it yet—someone who can benefit from being around other patients. Groups may not be ideal for very frail elderly people with vision, hearing, or mobility issues, Harris says.
Switching to a group-appointments schedule can be very helpful for a busy practice that can no longer handle drop-ins or that has an extended wait time for appointments. Instead of blocking off an entire day to see eight to 10 patients for 15 minutes each, Harris says, you can take care of those people in an hour or so and leave the rest of the day open for other patients.
“If you want to increase productivity, increase patient satisfaction, and get patients seen in a timely manner, it might be worth pursuing,” she adds.
Harris predicts group appointments will become even more popular as research demonstrating their effectiveness comes into circulation.
“I think this is a fantastic role for PAs and NPs,” she says. “It really highlights our unique contribution to medicine.”