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Health Care: Group doctor visits gain favor, show results

PHYSICIANS FIND MEETINGS MORE EFFECTIVE THAN RUSHED APPOINTMENTS; PAY STILL ISSUE

Though it’s not the first and it certainly won’t be the last North Bay medical group to consolidate, the dissolution of what was once the county’s largest primary care practice comes as yet another sign of the changing business of health care.

As in the case with PCA and others who consolidated just in the last year, stagnant reimbursement rates and increasing cost of care led the group to seek the backbone of larger economies of scale.

But even as PCA is just days away from being absorbed by two larger organizations, group President Dr. Bo Greaves said it is innovation that will eventually need to be the saving grace of all providers, no matter their size.

“Most physicians realize that they seriously need to redesign the way they give care, and they would love to, but they just don’t have the time,” said Sandra Newman, health policy director for the California Academy of Family Physicians.

“When you are seeing patient after patient just to make sure you can cover your overhead and keep your doors open, it’s difficult to find the time to completely change how you’ve provided care for your entire career.” In private-payer and state-reimbursed practices, physicians are paid according to the number of visits they have rather than the actual outcomes of care. Just to stay afloat, several North Bay doctors said they often only have time to spend 15 minutes with each patient.

“I always tell people that sometimes I feel like a mouse caught in a maze. There is something really frustrating about going in and out of room after room after room, not being able to expand on discussion,” said Marin Community Clinics Medical Director Dr. Georgianna Farren.

To address this problem, Ms. Newman said the group is pushing doctors to jump on one increasingly prevalent innovation to care: scheduling group medical visits.

“We have found, particularly for diabetes and other chronic-disease management, doctors have said group medical visits are a great way for them to feel like they are preserving that quality of care,” Ms. Newman said.

Though the model was developed in the early ‘90s, it has only in the past few years really gained momentum in the North Bay, according to local doctors. But so far they have had significant results.

Sutter Medical Foundation North Bay physician Dr. Sean Gaskie said he was the first to test the model locally, spearheading a diabetes group with the Santa Rosa family residency clinic several years ago.

“I got interested in the program when we started looking for better ways to manage chronic-illness care, which is getting terrible and is something we now spend a bulk of our time doing,” he said. “We weren’t sure what to expect, but it was unbelievable how quickly these patients got better medical markers. In just a couple of months, they were light years ahead of where they were when it was just one on one.”

Though it is popular for diabetes patients, it is also used in the same way for an assortment of conditions, including pain management, prenatal care, arthritis, hypertension, heart disease and others.

During a group medical visit, each patient receives all of the services included in more traditional meetings, including lab work-ups, prescription adjustments, examinations and vital-sign check-ups on a one-on-one basis. But instead of 15 minutes with their doctor, the group of usually eight to 15 has one to two and a half hours with providers.

“Diabetes patients are the perfect example of a chronic-disease model that works well in a group process,” said Sutter diabetes specialist Peter Baginsky.

“When you have peer encouragement it has a far broader impact than just a doctor telling you to do something. That way they are doing something they want to do rather than what they are told to do.”

In most cases, after or while patients wait for their individual evaluation, the meeting starts with a short educational presentation by the physician, nurse or other expert. Then, the bulk of time is used for patient questions and discussion.

“We all know that any primary care physician can look at their day or week and count how many times they say the same thing. But the real power is not so much being able to say things to more people at once, it’s getting a group of people together who share the same condition to hear questions from each other, get advice. They don’t feel so alone with their illness,” said Dr. Greaves, who hosts monthly, 90-minute diabetes groups.

Though research has proven higher patient satisfaction and better health outcomes, the biggest barrier is again the dollar. Most payers, including Medicare and Medi-Cal, do not reimburse the visits as they would a traditional medical check-up. Some will allow the bill if the doctor can prove they had one-on-one face time with the patient, but that requires more work, and in most cases the physicians offer the groups as a community service.

The North Bay’s largest HMO, Kaiser Permanente, offers an extensive array of group medical appointments, helped by its payer model.

“I wanted to do this in a way that increased quality of care but also didn’t lose the personalization. And so far I have gotten excellent feedback,” said Kaiser Santa Rosa Medical Center Dr. Hari Lakshmanan, who has led a carpal tunnel group for three years.

It offers meetings for hepatitis, prenatal, headaches, mental health and others.

Sutter’s Dr. Gaskie said the treatment model represents change from within the medical profession.

“I was attracted to this initially because it follows that line of changing medical care by changing physician behavior. We are not just subject to the changing conditions of our patients, we have to change ourselves,” Dr. Gaskie said.

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Submit items for this column to D. Ashley Furness at 707-521-4257, afurness@busjrnl.com or fax 707-521-5292.