Sharing Knowledge, Sharing Support With Shared Medical Appointments

Want to know what patients are saying about their shared medical appointments? Check out the article in the Winter 2005 issue of Cleveland Clinic Magazine Online! and tell us what you think about shared medical appointments by taking our Readers’Poll. Go to www.clevelandclinic.org/clevelandclinicmagazine.

Q. What is a shared medical appointment?
A. Shared medical appointments, which we call "Clinic Care Plus," don’t replace an office visit – they are one. But they are 90 minutes, rather than the usual 10 or 15. During the appointment, while the physician does individual private exams in a nearby exam room, a nurse or other support person, such as a health psychologist, does patient education that’s appropriate for that particular group, finds out what prescriptions need filling, and gets patients’ questions ready for discussion.

When the doctor returns, the rest of the appointment is spent discussing individual patient concerns one-on-one with each patient, but in a group setting where others can learn. Because of the one-on-one encounters with the physician, and the intensity of the patient education that’s going on, group appointments are very interactive. Patients aren’t just hearing what the doctor or nurse says, they are learning from each other, too.

Q. How are privacy issues handled with group appointments?
A. Doctors don’t do private types of exams in front of the others during the appointment -- they take patients to an exam room. And every patient signs a confidentiality statement making everything they hear in the shared appointment confidential. The people who participate in our groups take the statement very seriously. That’s been the experience nationally, too.

Q. What types of shared appointments are offered at The Cleveland Clinic?
A. Right now we offer two kinds of appointments. One is for people who are undergoing an annual physical. It’s scheduled for people with similar medical concerns, and it’s usually done with a gender- and age-specific group, such as women under the age of 50 years.

The other type is for follow-up care. Currently we are offering shared appointments for patients with hypertension and cardiac risk factors; diabetes; movement disorders; asthma; fibromyalgia, chronic pain and weight loss management; post-cancer treatment and post-bariatric surgery care; women’s health and other medical or chronic conditions that require a checkup every three months or so. We are thinking about adding appointments for heart transplant patients. At these appointments there is really a lot of support -- and mentoring -- because when patients see and talk to each other they begin to realize that others have gone through the same thing, and that they aren’t just surviving, they are thriving.

Since everyone is there for the same reason, not only are these appointments effective for the patient, but they also are efficient for the physician -- who’d otherwise be giving the same information 10 or 12 times in one- to two-minute discussions. Instead, the physician can discuss a topic in more depth because there is more time available and many patients benefit.

Q. What’s been the patients’ reaction after they’ve had a shared appointment?
A. Feedback has been very positive. We were worried that people would feel that they were getting less care, but that’s not the case. In fact, 85 percent of those who have had a group appointment sign up for one again. And, our patient satisfaction surveys on the doctors who offer shared appointments shows patients have a higher satisfaction level in their group settings than in their individual settings.

I think patients find the whole experience better because they feel they are getting more time with their physician, more care, more information, and more support. And, because of where we are meeting – it’s not the exam room, we are sitting in a larger group, usually in a semi-circle – things are less rushed and stressful, too.

Q. What is the best group size for a shared medical appointment?
A. That depends on the purpose of the appointment. If it’s a group physical, it’s six to eight patients. If it’s for follow-up care, it can be between 10 and 16 patients.

Q. When did the Clinic start offering shared appointments?
A. We’ve been offering them since October of 2002. As of the end of August 2004, we’ve had 5,518 patients participate in 718 group appointments. This is a national trend. Many other major academic medical centers also are offering group appointments.

Q. Who is the ideal patient -- the one who’ll benefit most -- for a shared medical appointment? And who are they not appropriate for?
A. Doctors know their patients, so they are only going to suggest them for patients who’ll benefit from them. That said, it’s most appropriate for people who need a routine physical or who are dealing with chronic conditions or illnesses, or are recovering from procedures -- such as a hip replacement or bariatric surgery-- that require close and coordinated follow-up care.

It’s not appropriate for very young children. And it’s not appropriate for people with hearing loss, or for those who are cognitively impaired or have serious psychiatric problems. It’s not for people who require an interpreter, because of difficulties with English. And it’s not for those who will have trouble maintaining confidentiality.

Q. How do patients sign up for a shared medical appointment?
A. We are offering them system-wide -- here in Northeast Ohio and in Florida -- so all it takes is a call to their physician. Doctors are being proactive, too. If they think a patient would benefit from receiving their health care in a shared setting and a longer, more interactive appointment, they are suggesting them.

Q. What happens if a patient decides they don’t like or want to participate again in a shared appointment?
A. Shared appointments are an option. If patients find they are uncomfortable in a group, they can switch back to individual office visits. But we don’t see that happening very often. Patients seem to like group appointments, especially if they miss one, because it’s easy to reschedule them into the doctor’s next group appointment.

Q. How are shared appointments billed?
A. Shared appointments are covered by insurance and Medicare. Doctors are thorough and deliver the medical care that would normally be provided in a regular office visit, so patients are billed as if they’d been seen in a regular, brief office visit. We don’t bill for 90 minutes of time, and we don’t bill for a patient education session. That’s why we call this program "Clinic Care Plus." The "plus" is the education, the support and the motivation that patients get in a group appointment.

Source: Cleveland Clinic Magazine, Winter 2005