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Marketing shared patient appointments

As health care reform kicks in to high gear, a new innovation in health care delivery is being touted at Cleveland Clinic: shared patient appointments. On the surface, this idea seems so efficient and social as patients with similar medical problems sit around in a group therapy session that masquerades as health care. After all, […]

By Westby G. Fisher, MD on August 09, 2013

As health care reform kicks in to high gear, a new innovation in health care delivery is being touted at Cleveland Clinic: shared patient appointments. On the surface, this idea seems so efficient and social as patients with similar medical problems sit around in a group therapy session that masquerades as health care. After all, with the large influx of new patients to our health care system underway and the limited health care personnel resources available, the push for such a model was inevitable.

But many Americans are also noticing another disturbing trend: higher insurance premiums to offset the cost of those who do not have sufficient resources to pay for their care.  While the reality of our higher health care costs demand that the added costs be paid by someone, I suspect most of those who will be paying higher premiums didn’t think they’d have to “share” their physician appointments with others.

But here we are.

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For large health care systems, shared patient appointments offer the promise of high revenue streams with low overhead costs.  As such, there is no downside to promoting such a model:

Since 2005, the percentage of practices offering group visits has doubled, from 6% to 13% in 2010. With major provisions of the Affordable Care Act due to be implemented by next year, such group visits are also becoming attractive cost savers — patients who learn more about ways to prevent more serious disease can avoid expensive treatments. (ed’s note: Sales pitch – there are no data that group appointments “prevent” more serious disease or “avoid” expensive treatments)

“It’s a different way of speaking about health that is more about friends around a circle learning together than talking with an authority figure in a white coat,” says Dr. Jeff Cain, president of the American Academy of Family Physicians, in describing shared medical appointments. Think of them as a blend between group therapy and support groups. The net effect is the same – a sense of comfort, support and even motivation that comes from sharing similar experiences. (ed’s note: Easy for him to say.  Any proof?)

Looking at this, how could anyone argue?  It seems like such a helpful premise.  But patients subjected to such a system have to agree one very important issue: surrendering their privacy:

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Westby G. Fisher, MD Website Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in […]

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But they do require divulging and discussing private medical information in front of strangers (albeit ones who have signed waivers not to talk about other patients’ medical histories outside of the visit).

We should ask ourselves: how will assurances of patient privacy in such a setting be enforced?  If another patient discusses a participant’s health care needs and concerns outside of such a meeting, will that person be reprimanded?  If so, how?  And what extent must HIPAA privacy laws be waved as a result of this model?
These are only a few of the concerns for patients.  We should also ask what the outcomes are for such a model?  What value to patient’s get for their health care dollar if another member of the group is more vocal and insists on speaking while others have to remain mute?  Will they be guaranteed an opportunity to have their question(s) addressed?  And how will patient’s be selected for participation in these groups?  Will diagnosis codes be used?  If so, what happens (psychologically) to a group of early diabetics who are placed in a group with a diabetic with more extensive disease?  Might there be negative repercussions when a young diabetic sits with a diabetic amputee or renal patient?
Efficient health care delivery models are needed going forward, but attempts at social re-engineering that can alienate some patients in favor of others and stands to profit a system rather than the individual demands careful evaluation before marketing such a model as gospel to our health care system.

-Wes

Westby G. Fisher, MD
Website

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.