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Group Medical Visits – Part 1
Learning Session 1
Presenter’s name here
Location here
Date here
www.pspbc.ca
Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
- Grants/Research Support: PharmaCorp ABC
- Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
- Consulting Fees: MedX Group Inc.
- Other: Employee of XYZ Hospital Group
2
Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
- [Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
- [Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
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Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
4
Certification
 Up to 21 Mainpro+ Certified credits for GPs awarded upon
completion of:
› All 3 Learning Sessions (NOTE: Credits and payment will be based on
the exact number of hours in session)
› At least 1 Action Period
› The Post-Activity Reflective Questionnaire (2 months after LS3)
 Up to 10.5 Section 1 credits for Specialists
› All 3 Learning Sessions (NOTE: Credits and payment will be based on
the exact number of hours in session)
› The Post-Activity Reflective Questionnaire (2 months after LS3)
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Update/revise
Action Plan
Report of AP1
experiences &
successes
Payment for:
PMV (optional)
LS1
Action Period 1
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Refine
implementation;
embed & sustain
improvements
attempted in
practice via
Action Plan +
AP2
requirements
Interactive
group learning
Finalize Action
Plan
Report of AP2
experiences &
successes
Payment for:
LS2
Action Period 2
LS3
Reflection
Interactive
group learning
Learning Session 3
Create Action
Plan (using
template)
Planning & initial
implementation
in practice;
review of Action
Plan &
improvements
attempted in
practice + AP1
requirements
Action Period 2
Interactive
group learning
Learning Session 2
Opportunity
for in-practice
visit to
introduce
applicable
EMR-enabled
tools &
templates prior
to LS1
Action Period 1
Learning Session 1
Pre-Module Visit
Learning Session & Action Period Workflow
Reinforce &
validate practice
improvements
GPs & Specialists
complete PostActivity
Reflective
Questionnaire
(PARQ) 2 months
after LS3 &
submit to PSP
Central
Payment Stream 1 (ideal)
Current Rates:
GPs
Specialists
MOAs
Hourly Rate
$125.73
$148.31
$20.00
Action Period 1
$880.10
$1,038.16
N/A
Action Period 2
$660.07
$778.62
N/A
Payment made after attending LS2
Payment made after attending LS3
GPs:
GPs:
PMV
= $125.73
LS2
= $440.05 ($125.73 x 3.5hrs max.)
LS1
= $440.05 ($125.73 x 3.5hrs max.)
AP2
= $660.08
AP1
= $880.10
LS3
= $440.05 ($125.73 x 3.5hrs max.)
TOTAL
$1,445.88
TOTAL
Specialists
Specialists
LS1
= $519.08 ($148.31 x 3.5hrs max.)
LS2
= $519.08 ($148.31 x 3.5hrs max.)
AP1
= $1,038.16
AP2
= $778.62
$1,557.24
LS3
= $519.08 ($148.31 x 3.5hrs max.)
TOTAL
TOTAL
MOAs
$1,816.78
MOAs
PMV
= $20.00
LS1
= $80.00 ($20.00 x 4hrs max.)
LS2
= $80.00 ($20.00 x 4hrs max.)
$100.00
LS3
= $80.00 ($20.00 x 4hrs max.)
TOTAL
TOTAL
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$1,540.18
$160.00
Welcome
Dr. Fines Group Medical Visit
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Introduction
 Group medical visits are one-to-one medical
appointments in a group setting
 Self management empowers patients to become
partners in their care
 Health literacy is about ensuring patients
understand basic health information
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Practice Reflection
 Have you ever organized a group medical visit to
deliver individual care to multiple patients at once?
 Have you introduced patient self-management
strategies into your practice?
 Have you considered the Literacy of your patient?
 Have you made any changes based on your
practice self assessment?
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Group Medical Visits
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Fresh Ideas Video
http://www.youtube.com/watch?v=Fi9nTCZoRfA
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Group Medical Visit Benefits
 Increase patient doctor
relationship
 Improve patient self
management
 Improve access
 Efficient way to meet
clinical guidelines
 Improve patients
understanding of their
health issues
 Greater attention to
psychosocial
 Improve patient
satisfaction
 Support other patients
 Improve provider
satisfaction
 Decrease patient phone
calls
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 Improve cost
Literature – Dr. Ed Noffsinger
 200%-311% ↑ in MD productivity
 92% ↑ in pt satisfaction
 87% of patients returned to groups for their care
 Up to 73% ↓ in wait times
(Noffsinger E, Various studies)
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The Power of Group Medical Visit
A REAL, local example from Masset, BC
Significant improvement in completion and target rates
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Measures
Massett
Clinic’s Goal
All BC (data)
Masett Clinic
Data (1:1
visits)
Masett Clinic
Data (GMV)
A1c < 7.0
85%
45%
58%
75%
B/P < 130/80
60%
47%
53%
62.5%
Annual LDL < 2.5
70%
34%
38%
60%
Annual ACR
< 2.0M < 2.8F
85%
32%
44%
50%
Annual foot exam
90%
36%
83%
100%
Annual documented
self management goal
85%
34%
74%
100%
Why a group medical visit instead of 1:1?
Physician Quote:
Dr. Becky Temple
“Since starting group medical appointments for my
depressed and anxious patients I have felt much more
satisfied with the care I am providing....allowing me to
share CBT exercises, and medication information in a
much more detailed manner to several patients at one
time; patients find it valuable to discover that they are not
alone in their struggles with symptoms and to hear about
how others have successfully managed their illness with
medications and other therapies....much more powerful
than me saying so as a physician"
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Patient Quote:
Brian
“Group medical visits, I think everyone should attend at
least one and let them be the judge. Most of my doctors
appointments are group medical appointments”.
“Questions that I would have liked to have asked but
didn’t have the courage to, someone else asked and I
learned from that. Questions that I didn’t even think to
ask were asked and I learned even more”.
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Group Visit Models
Model 1:
Cooperative Health Care Clinic (CHCC)
Model 2:
Drop-in Group Medical Appointments (DIGMAs)
Model 3:
Physicals Shared Medical Appointments (SMAs)
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Common Features of All Group Medical Visit Models:
- These are 1:1 medical appointments that happen in a
group setting (i.e. assessment, diagnosis, prescription
renewal, review of labs)
- Reduce repetition and duplication
- In all cases patients will be asked to sign patient
confidentiality forms
- All physicians and patients will fill out an evaluation form
- Groups medical appointments will begin on time and end
on time
- Patients have 90 minutes with their physician
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Cooperative Health Care Clinic (CHCC) Model
Key Concepts:
- Pre-book 10-15 high-utilizer patients
- Book the same people in the same group on a
regular basis e.g., monthly/quarterly
- 90 - 120 minutes in duration
- Consist of individual 1:1 with doctor done in a group
- Review of test result
- Question & answer period
- Topic for education (30 mins.) based on group decision
- Limited private consultation with doctor after the
group
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Drop In Group Medical Appointment (DIGMA)
Key Concepts:
- 80% pre-booked
- Can be booked from a patient registry for recall
- Can be Homogeneous group (single issue)
- Can be Heterogeneous group (various conditions)
- 12 – 16 patients see their doctor 1:1 in a group
dynamic
- Education is opportunistic with each patient
interaction
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Shared Medical Appointments (SMAs)
Key Concepts:
- Pre-booked (80%)
- Shared physicals appointment (ideal for prenatal,
baby-wellness, women’s and men’s health needs,
or cardiovascular follow up appointments)
- 8-12 (max) patients
- First half of the session is a private physical exam
by doctor, while other group members are sharing
& learning with behaviourist
- Second half is doctor patient interactions in a
group
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GMV Roles
 Physician
 Behaviourist
 MOA
 PSP Coordinator
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Physician Role
 Physician will begin and end appointments on time
 Have a face-to-face appointment done in a group setting
 Patients that need to be seen privately can do so at the
end
 Share patient clinical data
 Chart during the group meeting
 Order lab tests
 Prescriptions
 Document patient self management plan
 Participate in short debriefing at the end of GMV
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Behaviourist Role
 Arrives 15-20 mins early – takes BP, weight, etc
 Welcomes patients by asking each to identify their main
concern (writes them on flip chart)
 Manages group dynamics
 Promotes meaningful group discussion while GP is
doing chart note
 Addresses confidentiality
 Collects evaluations
 Begins group on time, and ends on time
 Participates in short debriefing at the end of GMV
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MOA or Office Staff Role
 Prepares for Group Medical Visit:
 Organizes the group space
 Overbooks by 25% (stats show 81% of pre-registered
actually show up)
 Telephone or mail or email invitation letter
 Makes a patient information package including
confidentiality and evaluation forms, patient self
management action plans, most recent flow sheets, etc.
 As patients arrive assist with BP, weight, foot exam, etc
and document
 Track data/narrative reports/measures
 Participates in short debriefing at the end of
GMV
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Coordinator Role
 Encourages role maximizing, and facilitates role
expansion and any additional training
 Finds a suitable behaviourist match (requires
doctor/MOA input)
 Attends GMV’s until independent (as needed)
 Facilitates team debrief after GMV (as needed)
 Troubleshoots issues (i.e. where to hold the GMV)
 Continues to keep in touch for support (the whole
practice team)
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Mock Group Medical Visit
Test in a team at your table the following:
1. Appoint one person to be the doctor
2. Appoint one person to be the behaviourist
3. Appoint one person to be the MOA
4. The rest can be patients
Now run through a test
Be prepared to share with the group
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