Part B Insider (Multispecialty) Coding Alert

Published on Wed May 04, 2005 PDF

Drop-In Group Appointments improve efficiency, patient satisfaction

What if you could treat all your chronic patients more efficiently, and improve their outcomes?

Maybe you can. Many medical practices are experimenting with Drop-In Group Appointments (DIGMAs), a new system under which patients with the same condition see the doctor in a group instead of individually. Because the physician spends more time with the patients as a group than he or she could one-on-one, the patients feel more satisfied and have more of their questions answered.

With DIGMAs, you have "prompt access to your own physician. You can be seen any week or day you want to be seen," says Ed Noffsinger, a San Diego, CA health psychologist who has worked with Kaiser Permanente. Patients will typically have 90 minutes with the doctor instead of six or seven minutes, plus "you get the help and support of other patients built into your experience."

Each patient receives personalized follow-up, adds Noffsinger, who pioneered the approach.

Yet the DIGMA approach is more efficient than the traditional version, because the doctor can see a dozen patients in 90 minutes instead of two and a half hours, says consultant Owen Dahl with SALCO in New Orleans.

Medicare doesn't cover group appointments, but "we call them shared medical appointments, suggesting that these are actually individual medical visits with the doctor that happen to have observers in the room," says David Hooper, VP of clinical operations with the Palo Alto Medical Foundation. It's no different than a mother bringing several kids to the pediatrician at once for the doctor to examine one by one.

A few years ago, Palo Alto Medical Foundation contacted its local carrier medical director, who was "supportive of the concept" but couldn't give a definite answer, reports Hooper. Since then, PAMF has billed for the individual "visits with observers," but not for any time the patients spend receiving counseling or education as a group. Medicare definitely doesn't pay for group education, so PAMF either offers the service for free or for a small charge to the patient, Hooper says.