Group Medical Visits Offer Upsides and Downsides
Robert Rifkin, CPA, MBA
Are group medical visits right for your practice? This service may not be as “outside-the-mainstream” as it first appears. Rather, group medical visits actually can be an effective way to enhance your patient services by enabling physicians, practitioners and patients to gain insights and share information in a way that simply cannot occur on a one-to-one basis. The Cleveland Clinic first offered shared medical appointments in 1999. Mass General and University of Wisconsin Hospitals are among other major health care practices that have also established group visit programs. This article looks at how group visits work and discusses the benefits and drawbacks.
Are group medical visits a viable option for your practice? They may not be as “outside-the-mainstream” as they first appear. Rather, they actually can be an effective way to enhance your practice’s services by enabling physicians, practitioners and patients to gain insights and share information in a way that simply cannot occur on a one-to-one basis. The Cleveland Clinic first offered shared medical appointments in 1999. Mass General and University of Wisconsin Hospitals are among other major health care practices that have also established group visit programs.
Here is a look at the upsides, and some potential downsides, of group visits.
How do Group Visits Work?
There are two types of group visits. The first is the shared medical appointment (SMA) or the cooperative health clinic (CHC), where eight to 12 patients with the same chronic condition meet with a doctor for two to three hours. Much like a support group, SMAs or CHCs are held monthly or quarterly with the same group of patients. Patients who participate in SMAs or CHCs sign paperwork agreeing to share health information with both their doctors and the other patients participating in the group.
After your staff registers the patients, verifies insurance coverage and takes vital signs, the session begins with an introduction of the day’s topic. The doctor then addresses each patient individually about his or her specific condition and creates individual treatment plans. During the meeting, medical chart entries are made as though it were a series of separate private visits. Patients can ask questions about their own or other patients’ cases.
The second form is the drop-in group medical appointment. These meetings typically last half as long as an SMA or CHC, are attended by any patients who choose to appear and tend to address a variety of episodic or acute care conditions.
What are the Benefits?
Group visits have the potential to satisfy everyone involved. Physician productivity increases, because they see more patients in a day and increase their primary care billings. And group visits can be a nice departure from the usual routine. Several clinical disciplines are involved in the visits, thus improving coordination of care. This can lead to fewer specialist referrals, ER visits and repeat hospital visits by group members. Patients may be more satisfied with their doctors and trust them more because conversations are informal and informative. They are also supported by other group members whose experiences and questions could prove instructive.
In addition, patients will become more knowledgeable about the disease processes affecting them, thereby improving their overall health care education. And, participants may better adhere to their medication regimens and self-care guidelines with the support of others.
What are the Downsides?
Privacy issues can arise in a group session. Before joining, advise patients that personal health information may be disclosed during a group visit and that they may be asked to sign a HIPAA compliant release and waver acknowledging this fact. Also, it may take a few sessions before the practice becomes comfortable with group visits. Your staff will need to explain the purpose and structure of the meetings to patients. And they will need to gather the same types of information from attendees as they would for an individual office visit. In addition, doctors will need to develop a new presentation style for these meetings.
A common question about group medical visits concerns billing. No third-party payers currently distinguish between group and individual visits. Plus, there is no CPT code for group visits. So it is best to bill for each patient as though he or she had been seen individually. Most of the time that means using standard evaluation and management (E/M) codes 99212 to 99215. Some coding consultants have suggested using 99499 (unlisted evaluation and management service) and 99078 (physician educational services rendered to patients in a group setting). Make sure you check with the appropriate payers beforehand. The same documentation must be completed for components of the visit, such as vital signs, lab tests, medical history, physical examination and therapy decisions.
Would It Work for You?
Group visits are an intriguing option that can add a valuable dimension to patient care. Of course, it is important to assess whether particular patients will find group visits therapeutic or daunting and to schedule sessions accordingly. But, if used judiciously, group visits can create lasting bonds between patients — and between patients and their physicians.
Starting a Practice: How to Develop a Budget
Jason Flahive, CPA
When a physician opens a practice, establishing a sensible budget should be top of mind. He or she needs one that both facilitates getting the practice up and running and helps guide it going forward. This article explains some significant aspects of both the cost and the revenue sides of a budget, noting that some will be decided by the practice’s economics and others will be set by the local economy and what the competition is for good employees in the area.
When starting up a practice, establishing a sensible budget should be top of mind. You need one that both facilitates getting the practice up and running and helps guide it going forward. Every budget has two sides: cost and revenue. We will discuss both.
Defining Your Operational Cost
Practice generally consist of three categories: space, equipment and staffing. Start by determining expenses for the first six months and then move on to what you will need by the end of the first year. Decide:
- The type of practice you want;
- How much space you need and its location;
- What type of equipment you will need;
- Whether you plan to rent or own equipment; and
- Whether you plan to rent or own your space.
Another significant consideration is the type and number of staff, how much to pay them and what benefits you will offer. Determining appropriate and competitive compensation can be challenging. Create job titles and descriptions to compare to Department of Labor data, as well as local and regional data. Create a range of compensation amounts, not a fixed number, because you will need to pay based on experience.
Benefits can be a complicated issue, too, especially with the uncertain health care market. Typically, it is wise to rely on local standards as a benchmark, which will require talking to colleagues in the area. Other costs to anticipate include outlays for marketing and advertising, different forms of liability insurance, facility repairs and maintenance, postage, contract management services, billing, security, medical waste disposal, and communications and technology.
The Medical Group Management Association has benchmarking data on specialties. It also has calculators for determining budgets and expenses compared to the national average. Various professional organizations within your specialty typically have benchmarking data as well.
Minding Your Personal Expenses
Your personal expenses also affect your practice budget. These typically consist of mortgage or rent; car payments, gas and insurance; credit card debts and other loan payments; and essentials, such as food and utilities. So, you might calculate that it will take $15,000 per month to run your practice. At the same time, your personal budget is $6,000 per month or, in total, $21,000 per month.
Estimating Your Revenue
On the revenue side, you will need to estimate how much you are likely to be paid for each patient. For instance, if you plan to collect $100 per patient visit, you’ll need at least 210 patient visits per month to meet the aforementioned $21,000 per month budget. With this established, you can calculate whether you have enough funds in your budget to make contacts and develop referral sources to generate 210 patients per month using advertising, marketing and communications.
Getting Off on the Right Foot
Clearly, some aspects of your budget will be decided by your practice’s economics and your own philosophy. Others will be set by your local economy and what the competition is for good employees in your area. Work with your CPA and banker or call us to help develop a solid budget that gets your practice off on the right foot.