Three simple words: Group medical visits. Before you dismiss the idea, keep in mind that it has been a well-established offering of many practices for years. There is a reason why: Both doctors and patients can gain many benefits simply from listening to each other.

How It Works

There are two types of group visits. The first is the shared medical appointment (SMA) or the cooperative health clinic (CHC), where 8-12 patients with the same chronic condition meet with a doctor for two to three hours. Much like a support group, SMAs or CHCs are held monthly or quarterly with the same group of patients.

After staff registers the patients, verifies insurance coverage and takes vital signs, the session begins with an introduction of the day’s topic. The doctor then addresses each patient individually about his or her specific condition and creates individual treatment plans. During the meeting, medical chart entries are made as though it were a series of separate private visits. Patients can ask questions about their own or others’ cases.

The second form is the drop-in group medical appointment. These meetings last half as long as an SMA or CHC, are attended by any patients who choose to appear and tend to address a variety of episodic or acute care conditions.

Everyone Wins

Group visits have the potential to satisfy everyone involved. Physician productivity increases, because they see more patients in a day and increase their primary care billings. Group visits can also be a nice departure from the usual routine.

Several clinical disciplines are involved in the visits, improving coordination of care. This can lead to fewer specialist referrals, ER visits and repeat hospital visits by group members.

Patients may be more satisfied with their doctors and trust them more because conversations are informal and informative. They are also supported by other group members whose experiences and questions could prove instructive.

Patients will become more knowledgeable about the disease processes affecting them, too, improving their overall health care education. Additionally, patients may better adhere to their medication regimens and self-care guidelines with the support of others.

However, it is important to note that privacy issues can arise in a group session. Before joining, advise patients that personal health information may be disclosed during a group visit and that they may be asked to sign a HIPAA disclaimer acknowledging this fact.

Ground Rules

It may take a few sessions before the practice becomes comfortable with group visits. Your staff will need to explain the purpose and structure of the meetings to patients. And they will need to gather the same types of information from attendees as they would for an individual office visit. In addition, doctors will need to develop a new presentation style for these meetings.

A common question about group medical visits concerns billing. No third-party payers currently distinguish between group and individual visits. Plus, there is no CPT code for group visits. So it is best to bill for each patient as though he or she had been seen individually. Most of the time, this means using standard evaluation and management (E/M) Codes 99212 to 99215.

Some coding consultants have suggested using 99499 (“unlisted evaluation and management service”) and 99078 (“physician educational services rendered to patients in a group setting”). Make sure you check with the appropriate payers beforehand. The same documentation must be completed for components of the visit, such as vital signs, lab tests, medical history, physical examination and therapy decisions.

The Right Circumstances

There may be some pushback initially from certain patients who are used to seeing a doctor one-on-one. However, after the first couple of meetings, many participants bond well with their physicians and group members. That does not mean group medical visits will work for every practice. Nevertheless, under the right circumstances, they are a viable option.

For other ways to make your medical practice more efficient, or to discuss group medical visits in further detail, please contact Jason Flahive at [email protected] or call him at 312.670.7444.