Download SMA`s Part 2 (Con`t) - Diabetes in Control

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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Why SMAs Are Timely
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
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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Why SMAs Are Timely
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
Source: Schmucker D. Group Medical Appointments. 2006:12-14.
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SMA Overview
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
Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:4,9.
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SMA Overview
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
Source: AAFP Web site. Group visits: introduction:2.
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SMA Overview
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.
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SMA Overview
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.
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SMA Overview
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
Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:9,12.
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SMA Benefits
Patient-Centered Medical
Home (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
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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Types of SMAs
Three SMA Models
• Cooperative Health Care Clinic
(CHCC)
• Drop-in Group Medical
Appointment (DIGMA)
• SMA for Physical Exams
(Physicals SMA)
Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:122.
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Types of SMAs
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.
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Types of SMAs
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.
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Types of SMAs
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.
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Types of SMAs
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.
15
SMA’s Part 2
(Con’t)
• Studies Showing How Effective SMA’s Can Be
Source: Schmucker D. Group Medical Appointments. 2006:117-118.
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