Group appointments have their benefits

Practice Management. By Mike Norbut, amednews staff. Jan. 27, 2003.

PRACTICE MANAGEMENT

A column about keeping your practice in good health

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It's the age-old dilemma for a busy physician. There just isn't enough time in the day to meet the demand of patients, and five minutes in the exam room just isn't long enough to sort through their complicated problems.

Family physicians Cliff Fullerton, MD, and Kimberly McMillin, MD, certainly faced that issue in their own North Garland, Texas, practice. So they decided to offer group medical appointments, an idea that is slowly gaining momentum.

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Efficient? Definitely. Enjoyable? For both patients and physicians, the doctors say.

But profitable? Not yet.

Drs. Fullerton and McMillin, the two busiest physicians at Family Medical Center of North Garland, part of the Baylor Health Care System, started using the drop-in group medical appointment model about four months ago. A 90-minute group appointment is offered once a week and designed to accommodate between 12 and 15 patients.

The appointments are offered to returning patients with chronic conditions, like arthritis, hypertension or diabetes, or those with a nonemergency need, such as a sinus infection. A nurse takes everyone's vital signs and patients are asked to sign a confidentiality waiver.

While the term "drop-in" is used, patients are asked to register in advance, so the office knows how many people to expect. The doctors alternate in running the appointment on a weekly basis, and they have plans to expand it so they each have a weekly group appointment, once the idea generates more interest.

"We have to see 10 patients in an appointment to break even," Dr. Fullerton said. "We have not gotten over 10 yet, where it's financially good for us."

In a normal 90-minute period, the doctors said they would see six patients. If the group appointments are working at the maximum capacity, they could see twice as many patients or more in the same amount of time.

There are higher costs associated with the group appointments, however. The physicians pay a psychologist to assist in running the appointments, including getting them started and leading discussions while the physician examines one patient or completes paperwork.

The visits are billed the same way as a regular office visit, and patients are charged the same co-payment, but there is less work involved. For example, if more than one patient needs counseling on hormone replacement therapy, the physician only has to speak on the subject once, Dr. Fullerton said.

"You bill for what you did for that particular patient," he said. "If other patients benefit, that's their good luck. You save money for the insurance company that way."

While this approach doesn't automatically mean a profit for the group, there is a good will factor that can't be denied, physicians said. The appointments add flexibility in the schedule offering patients less waiting time, more same-day appointments, and, if they choose a group setting, more face time with the doctor. With so many people there as well, the appointments take on a support group feel at times.

"I'll find even though one woman might be there about back pain and might not have questions about menopause, she'll listen to the woman who's there for menopause because she knows it's coming," Dr. McMillin said. "I've found patients enjoy learning about other issues."

Edward Noffsinger, PhD, director of clinical access improvement for the Palo Alto Medical Foundation in northern California, is widely recognized as the originator of the group medical appointment idea. The Palo Alto group offers dozens of group appointments in several different specialties each week.

James Stringer, MD, a family physician with the Palo Alto group, has been offering group appointments, for patients needing physicals, once a week for about a year and a half. The idea was suggested to him by Dr. Noffsinger as a way to shorten patient wait times, "but it also has turned out to be enjoyable," Dr. Stringer said.

"Instead of six or eight coming in for separate visits, we can see them all at once," he said. "It also allows us to do some teaching."

Dr. Stringer said his group appointments, which generally have eight or nine patients, also include a behaviorist to keep them moving. And it appears there aren't any plans to pull the plug on the project, which seems to be doing more than just covering costs. Foundation directors "tell us it's working out financially," he said.

Drs. Fullerton and McMillin are confident the numbers will turn around for them too, once they are able to market their new style of care. While there are brochures touting the advantages of group appointments in the waiting area, the doctors fill most of the open slots through private invitations. When they have a patient who seems suited for a group appointment, they will suggest it to them. With the positive response they have received so far, it's only a matter of time until they start seeing 12 or more patients in future groups, they said.

"On the financial side, it's coming," Dr. Fullerton said. "The problem is, it's a brand new way of seeing the doctor, and they're not eager to do it until they've tried it."

Practice Management is written by members of our Business staff.