For some, seeing doc is a group activity

Washington Post
Monday, June 11, 2018

Walter Gardner knew his life was at risk: Nearly 100 pounds overweight, he had developed Type 2 diabetes and needed several prescriptions. Traditional medical appointments had little effect on the 55-year-old’s health. Then he was offered a way to spend more time with his doctor. Gardner seized the opportunity.

“I needed to do something or I probably wasn’t going to make it to 60,” he said.

Instead of rushed, one-on-one huddles in an exam room, Gardner joined eight to 10 peers in shared appointments with a physician to work on health challenges, nutrition and exercise for an hour or more each month.

Group medical appointments, which can last as long as 2½ hours, aim to offer patients expanded information, access and control over their health. They also help providers see more patients more efficiently.

Gardner joined sessions at Cleveland Clinic, which offers more than 200 types of shared appointments, including ones for diabetes or heart disease, male and female wellness, osteoporosis, prenatal and postpartum issues, chronic pain and cancer survivorship.

After more than 800 days, Gardner has dropped 103 pounds, trimmed 14½ inches off his waist and overcome his diagnosis as a diabetic. He has reported to his group as he catalogued his food intake, switched to a Mediterranean-style diet and revved up his exercise. He continues to tally the days since he changed his lifestyle and the hours he has exercised.

Introduced in the 1990s, the shared appointment has proved promising in areas such as managing diabetes and reducing emergency room visits. The large-scale impact of the approach is hard to quantify, however, because they can differ based on staffing and organization.

“When we think of advances in health care, they’re always technology or medication or vaccines, and it’s really time to look at the health-care model,” said Marianne Sumego, an internist and pediatrician who is the director of shared medical appointments at Cleveland Clinic.

Shared appointments allow providers to see more patients than their usual schedules allow, which may prove useful if a national shortage of tens of thousands of physicians develops by 2030, as data from the Association of American Medical Colleges projects.

Ten percent of family physicians offered group appointments in 2015, up from 5.7 percent in 2005, the American Academy of Family Physicians reports.

Group medical appointments were developed by Ed Noffsinger in his work as a psychologist at Kaiser Permanente in California. Sumego, one of the original providers, brought them to Cleveland Clinic in 1999. They are now considered an important, standardized option in the range of care offered there.

Increasing numbers of Cleveland Clinic patients participate in shared appointments each year, and internal surveys suggest a high level of patient satisfaction, particularly in access to care.

Sumego fields calls every week about shared appointments. “I think it’s gaining traction,” she said. “Our success indicates that it’s very sustainable, viable, and that it’s well received.”

Most insurance plans cover the appointments, which are billed as medical visits, similar to usual care. As with all change, there is a development and learning curve in implementing shared appointments, but ultimately shared appointments lower costs of care, Sumego said.

The power of a group can be palpable: Sumego recalls a diabetic who told his fellow patients he was having trouble because he worked a third shift and was not getting lunch. Two others in the group also worked third shifts. They told him that he needed to talk to his boss and then explained what they do and how they take their medications.

Cleveland Clinic addresses privacy concerns by requiring patients to sign confidentiality paperwork and by having its staff remind patients “how we really want to respect (all participants) and keep the information within the room,” Sumego said.