Group Medical Visits Offer Upsides and Downsides– July 31, 2017

Are group medical visits a viable option for your practice? Many physicians and practitioners are apt to dismiss the idea. But group visits can be an effective way to enhance your practice’s services — enabling physicians, practitioners and patients to gain insights and share information in a way that simply can’t occur on a one-to-one basis. Here’s a look at the upsides, and some potential downsides, of group visits. 

How 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.
 
After staff register the patients, verify insurance coverage and take 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 others’ 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. 

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, 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’re also supported by other group members, whose experiences and questions could prove instructive.
 
Patients will become more knowledgeable about the disease processes affecting them, too, 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. 

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 disclaimer 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’ll 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’s no CPT code for group visits. So it’s 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.
  
Group visits are an intriguing option that can add a valuable dimension to patient care. Of course, it’s 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.
 
Contact Kathy Walsh at kwalsh@cohencpa.com or a member of your service team for further discussion.
 
Cohen & Company is not rendering legal, accounting or other professional advice. Any action taken based on information in this blog should be taken only after a detailed review of the specific facts and circumstances.