More for less: Group sessions please patients
Seniors meet monthly to learn, check health
Can you give patients more attention with less time? That may sound impossible, but some medical groups have found a way to make older patients feel that they receive more and better care even while their physicians spend less time per month per patient attending to their individual needs.
Kaiser Permanente Colorado in the Denver area began offering 90-minute group sessions with about 20 seniors each in 1991. Now, some 34 groups meet monthly, including several with various ages that are focused on a chronic disease, such as rheumatoid arthritis, fibromyalgia, and diabetes.
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Groups meet with their physicians and nurses and often hear a speaker on a topic of mutual interest, such as understanding managed care, coping with depression, or breast cancer. At the end of the session, the physician speaks individually with patients and reviews their personal health charts, including their blood pressure and medications.
The physician also reserves time to see patients privately in an exam room, if necessary, says Marlene McKenzie, RN, MN, research project coordinator for senior programs at Kaiser Colorado. The group sessions are designed to replace routine visits, although group participants may make office appointments for urgent care, she says.
With a two-year controlled study sponsored by the Robert Wood Johnson Foundation in Princeton, NJ, Kaiser hopes to learn the impact of the group sessions on patients' health and satisfaction. Although the program focuses on high utilizers, the primary purpose isn't to reduce overall utilization, says McKenzie.
"The heart of the program was to enhance quality," she says. "It was never set up as a cost-savings program." Rather, this is an "alternative form of care" that allows seniors to ask questions without feeling rushed, she says.
"The patients value the relationship they establish with their physicians," she says. "They benefit from being with other people who have similar health problems."
Scripps Clinic in San Diego developed a similar program in hopes of improving both the quality of patient-physician communication and the physicians' satisfaction. Primary care physicians' caseloads were growing rapidly, placing time pressures on individual office visits, says Scripps' vice president and medical director Dan Dworsky, MD.
"It's a way of leveraging the doctor's expertise and touch," explains Joan T. Kallin, MSN, GNP, director of geriatric outpatient programs.
At the beginning of each monthly session of Senior Group Partners at Scripps, Kallin and the physicians' nurses take the blood pressure of the patients, ask them about any concerns, and provide them with renewed prescriptions. Each patient brings along a personal health record, which is updated. (See sample patient portfolio, inserted in this issue.)
Then after participants have a few minutes to socialize with each other, the physician and/or an invited guest speaks on a topic and guides the discussion. A portion of the 90-minute session is reserved for the physician to speak individually with patients and review their personal health records.
Kallin coordinates the program, sending out invitations, arranging meeting space, and preparing manuals. Her salary and other expenses are covered by a donation from one of the practice's patients - Sol Price, founder of The Price Club discount chain.
Most patients are covered by capitated managed care contracts, although some with fee-for-service Medicare have joined sessions, Kallin says. The clinic can bill for those patients using CPT code 99078, which provides about $75 per person for physician educational services rendered to patients in a group setting, she says.
Scripps has introduced other enhancements as well. For example, when a new senior enrolls with the group, a member relations specialist calls and gets information on medical history. Someone on staff then arranges an initial visit with a doctor of the patient's choice. After the visit, the member relations specialist calls to see if the patient was happy with the experience.
Scripps doesn't have results yet of patient satisfaction or other outcomes among the Senior Group Partners. But attendance is high. In fact, not one session member has dropped out, says Dworsky.
Even if the program produces no actual cost savings, "It still would have two or three impacts that would make it a worthwhile program," he says. "It gives a physician a different way of practicing, which might prevent primary care burnout.
"The patient satisfaction is so high," he says. "Most of these people are ecstatic about the group; they're wondering why their friends' doctors aren't doing it."
Retaining loyalty is a valuable goal. Dworsky says that with Medicare, patients can change their medical group or plan at any time and aren't subject to an enrollment period. Frequent switching can be costly to groups with capitated contracts.
"Any group that's looking at living with managed care and looks at their demographics knows it's getting an aging population," says Dworsky. "If groups are going to exist in the future, they're going to have to learn how to care for these people more efficiently. They have to learn how to keep [patients'] satisfaction high and their disenrollment low."
Furthermore, the benefits of the program may appear in future years.
"I think our outcomes will not be truly measurable for about 10 years, [when we] see if these patients are healthier and make better health care decisions when they become frail," says Kallin.
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