SHARED MEDICAL APPOINTMENTS

Achieving Better Patient Outcomes and Organizational Efficiencies

Part 1 of 2

Provided as an educational service by Pfizer Inc.NPC0149B1 © 2010 Pfizer Inc. All rights reserved. April 2010

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Agenda

• Why SMAs Are Timely

• SMA Overview

• Types of SMAs

• SMA Effectiveness

• Next Steps

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Today’s Practice Environment

• The population is aging—the 65 years+ age group will increase by 78% by 2030

• Today’s patients bring in consumer ads or the Internet information

• Increasingly complex medical treatments require more patient education

Why SMAs Are Timely

Sources: He W et al. Current Population Reports. 2005:12; Noffsinger EB et al. Understanding Today’s Group-Visit Models:2.

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Today’s Practice Environment

• Busy physicians are backlogged for appointments

• Short appointments reduce communication time between physicians and patients

• Patients experience dissatisfaction with appointment length or waits for appointments

• Physicians may feel stressed and dissatisfied

Why SMAs Are Timely

Source: Schmucker D. Group Medical Appointments. 2006:12-14.

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What Are SMAs?

• An SMA (group visit) is a periodic medical appointment held by a physician for 90 or more minutes to provide routine or follow-up care to groups of patients

• The physician is supported by other health professionals in conducting the SMA

• Private one-on-one time with the physician is available to patients who want/need it

SMA Overview

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:4,9.

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Characteristics of SMAs

• SMAs are:– Voluntary and interactive– Care delivery systems (ie, not classes)– Designed to enlist patients in their own

care– Efficient and effective

SMA Overview

Source: AAFP Web site. Group visits: introduction:2.

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Patients Suited to SMAs

• SMAs are well-suited to:– Patients with chronic conditions

– High utilizers

– Those with extensive emotional, informational, or psychosocial needs

– Patients having difficulty making behavioral/ lifestyle changes—eg, smoking cessation, medication adherence

• Source: AAFP Web site. Group visits: introduction:1; Schmucker D. Group Medical Appointments. 2006:85.

SMA Overview

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Privacy Issues

• Anything patients say about themselves is not of concern regarding HIPAA–HIPAA requires written consent before providers

disclose patients’ personal information

• Patients sign privacy notice when entering meeting or exam room

• Oral privacy reminders are given at the beginning of each SMA

• Private time is available with the physician

Sources: Schmucker D. Group Medical Appointments. 2006:147-148; SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:9.

SMA Overview

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SMA Benefits

• SMAs offer:– More time and a more relaxed pace of care

– Increased patient education

– Peer support and encouragement

– The opportunity to identify psychosocial issues or previously unnoticed medical issues

– Care delivered by a team

– Opportunity for family/caregivers to participate

– Better customer focus

SMA Overview

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:9,12.

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Patient-Centered MedicalHome (PCMH)

• PCMH:

– Facilitates partnerships between patients and their physicians through a physician-led care team that takes responsibility for providing comprehensive, ongoing care

– Emphasizes support for patient self-management

– Focuses on improving patient access to care

• SMAs are aligned with PCMH principles

SMA Benefits

Sources: PCPCC Web site. Patient-centered medical home—from vision to reality:2; AAFP Web site. Patient-centered medical home checklist:2.

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Three SMA Models

• Cooperative Health Care Clinic (CHCC)

• Drop-in Group Medical Appointment (DIGMA)

• SMA for Physical Exams (Physicals SMA)

Types of SMAs

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:122.

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CHCC • Target population: Chronically ill, high utilizers, same 15-20

patients every month, same day and time• It is co-led by the physician and his or her nurse• Patient benefits:

– Access to physician and nurse on regular basis– Continuity of care– Peer interaction– Patient empowerment

• Outcomes measures:– Office visits, hospital admissions, ER visits– Improved quality of life, self-efficacy, and activities of daily living– Patient and provider satisfaction

• Variation: Disease-specific or specialty CHCC for patients with 1 diagnosis or same needs

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:99, 4, 99, 109. Schmucker D, Group Medical Appointments. 2006:40; Scott et al. J Am Geriatrics Soc. 2004:1468.

Types of SMAs

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DIGMA

• DIGMAs target 10-16 patients per session, with patients attending when they need care

• A multidisciplinary team supports the DIGMA• DIGMA types:

– Heterogeneous—each session open to most patients• Target census levels easiest to achieve

– Homogeneous—grouped by disease or level of utilization– Mixed—physician practice divided into 4 large groups, 1 for

each week of the month• Outcomes measures

– Patient access– Physician productivity– Patient and physician satisfaction

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:xxx, 4, 31, 35-38.

Types of SMAs

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Physicals SMA• Focus is on physical exams, with 6-9 patients per session

in primary care• Improves patient access to complete exams and

increases patient education delivered• Provides private exams to patients followed by interactive

group meeting• Can help work down backlog for physicals• Can be applied to specialty practices including:

– Well-baby checkups in pediatrics– Foot exams in podiatry– Intakes and follow-ups for knee and hip replacement in

orthopedics

Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009: 4, 12, 125, 127, 129.

Types of SMAs

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Customize SMAs

• SMAs need to be customized to the physicians who will be conducting them

• Consider the following when designing the SMA:– The most pressing problem in the physician’s practice

– How the SMA can help to solve the challenge

– The patient segment the physician wants to target• Is there a large enough segment to fill the SMA on an

ongoing basis?

– The resources available to the physician to support an SMA

Source: Schmucker D. Group Medical Appointments. 2006:117-118.

Types of SMAs

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SMA’s Part 2(Con’t)

• Studies Showing How Effective SMA’s Can Be

Source: Schmucker D. Group Medical Appointments. 2006:117-118.