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1/30/2015

Your Next Doctor's Visit Could Get Crowded

Group medical visits are catching on

Photographer: BSIP via Getty Images

In a typical doctor's visit, you wait around for a while, get your vitals checked, and spend a few minutes alone in a room with a physician. It's private and short. Some doctors, frustrated by a relentless schedule of 15-minute, one-on-one visits, are experimenting with appointments that are neither.

According to the American Academy of Family Physicians, around 10 percent of family doctors already offer shared medical appointments, sessions that bring together a dozen or more patients with similar medical conditions to meet with a doctor for 90 minutes. With pressure from the government and insurers to bring down the cost of care while treating the increasing number of people with health insurance, patients can expect group visits to become more common. "It’s efficient. It’s economical. It’s high-quality care when it’s done right," says Edward Noffsinger, a California psychologist who created the model in the 1990s at Kaiser Permanente, the state's largest health maintenance organization (HMO). 

In a group visit, exams and tests are still conducted privately, but patients discuss their ailments in front of the group. The theory is that each patient can learn from the others' experience, and doctors get to have a longer, more relaxed discussion instead of hopscotching to three or four exam rooms in an hour. "You have one appointment with 10 observers," says Marianne Sumego, an internist at the Cleveland Clinic. "Patients are really getting the equivalent of 10 visits." Sumego started doing shared visits 15 years ago and has led the health system's expansion of the practice in the past four years. She says Cleveland Clinic has conducted more than 10,000 group visits in recent years. The approach is particularly useful for patients who are managing such chronic conditions as diabetes, asthma, or osteoporosis, she says. Sumego also conducts regular group checkups for women. "This model is really attractive in being able to let me spend more time with my patients," she says.

As for the effectiveness of group medical visits, there haven't been extensive studies. An analysis of existing research published by the Department of Veterans Affairs in 2012 found that the approach helped diabetics control blood sugar and blood pressure, but what the impact is on hospital admissions or total health-care costs was less conclusive. There's some evidence that group pain treatment may help manage such conditions as back pain or arthritis, according to a review by the Cochrane Collaboration, which synthesizes medical evidence. Another Cochrane review, covering just two studies, found similar outcomes for pregnant women in group visits compared with those who got one-on-one prenatal care.

Marianne Sumego, second from left, leads a group medical visit at Cleveland Clinic.

Source: Cleveland Clinic

Here's what is clear: Seeing several patients at once can be good for harried doctors' finances. In 90 minutes, a physician might be able to complete five or six one-on-one visits. A group visit could allow doctors to see double that number or more in the same time, and medical assistants or nurses can take care routine aspects of care—checking patients in, taking vital signs, writing refills of medication.

Often it takes a fair amount of promotion by doctors to get patients interested in exploring group appointments, which require them to sign privacy agreements. "Patients have a lifetime of expecting a one-on-one visit," says Noffsinger. "We’re asking them to do something entirely different."

Noffsinger had spent years counseling seriously ill patients at Kaiser before he got sick himself in 1988, with a life-threatening pulmonary disease that kept him laid up for four years. While he was sick, Noffsinger realized he wanted to see his doctors without waiting for an appointment for weeks. He also wanted to spend more time with them and to connect with other patients who understood what he was going through. He realized that turning one-on-one visits into shared appointments could create enough breathing space in doctors' schedules to do all three.

After he recovered, Noffsinger started doing shared visits at Kaiser in 1996. He has since consulted around the world with doctors who want to try the idea, including at the Cleveland Clinic, hospitals on U.S. military bases, and the Veteran's Health Administration. He went to Boston for a few years, starting in 2007, after health-care reform under then-governor Mitt Romney expanded the number of insured patients in a market that already had some of the longest wait times in the country. "The demand for care had suddenly far exceeded the supply of care available," he says. With insurance coverage expanding across the U.S., group visits may follow.

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