Interest in shared medical visits increasing in region

Benefits of group visits include better patient outcomes, more flexibility in doctors’ day.

It’s a concept nearly 20 years in the making, but health providers locally are just starting to explore the realm of shared medical appointments.

Studies and published findings show group medical visits prove effective in helping people manage a chronic condition or new diagnosis while increasing a patient’s access to their physician and freeing up more of the physician’s time to treat other patients.

“Where people struggle is understanding their conditions and managing the burden and treatment of the disease on a daily basis,” said Cory Sevin, director at the Institute for Healthcare Improvement in Cambridge, Mass.

It’s for chronic conditions — such as diabetes, heart failure and obesity — that the model of shared medical appointments (SMAs) is most explored, Sevin said.

While an in-person visit to your physician lasts about 20 minutes, a shared medical appointment gives the patient access to their doctor and nurses for up to two hours. A group setting, officials said, allows patients to ask questions and hear responses to items they might not have thought of otherwise.

“It’s a patient-centered approach,” said Dr. Angela Fitch, a UC Health physician. “Studies show the end result is better outcomes. The idea came from the need to care for individual people but also whole populations.”

Fitch, medical director of the UC Health Weight Loss Center at West Chester Hospital, said the Greater Cincinnati region is “behind” in implementing SMAs. She returned to Cincinnati last year after a decade of running shared medical visits in Minnesota around obesity and weight loss.

Fitch said she’d like to introduce SMAs to patients at the UC Health Weight Loss Center, but hasn’t been able to yet due to needing adequate space and staff — two things she called the institution’s “biggest challenges.”

Fitch said with an impending physician shortage — a deficit of 62,900 physicians by 2015 and 130,000 physicians by 2025, according to the Association of American Medical Colleges — the expanded presence of SMAs will pop up out of necessity.

“It’s a way to get creative because we’re at a shortage of health care providers,” Fitch said.

Some physicians across Butler and Hamilton counties currently offer SMAs in areas of cardiology, orthopedics and diabetes.

For a year now, two Mercy Health medical practices — Deerfield Family Medicine in Mason and Eastgate Family Care in Cincinnati — have used SMAs to treat diabetic patients. And this month, Mercy Health orthopedic surgeon Dr. Francis Florez started offering shared medical appointments to hip and knee replacement patients.

Dr. Lynne Wagoner, a cardiologist at Mercy Health — Fairfield Hospital, said since October 2013 she’s offered SMAs to her heart failure patients following discharge from the hospital or an initial diagnosis. Patients meet in groups of eight every other week for eight sessions.

“We created an umbrella around the patient to keep them out of the hospital,” Wagoner said.

Wagoner said she sees about 60 heart failure admissions each month, and it’s the only cardiac condition increasing in prevalence.

Denna Dietrich, nurse practitioner at the Heart Institute at Fairfield Hospital, said SMAs are the joining of education, office visits and treatment into one package.

During the first part of group visits, patients socialize while each getting a one-on-one check with the physician to update vital signs and adjust medications, Dietrich said. Then the group discusses a different topic each week with an expert in that area, such as general information on heart failure and its symptoms; diet and exercise; and how to live with a new chronic diagnosis.

Patients attending the heart failure SMAs in Fairfield range in age from 23 to 79, said Rita Cassidy, heart failure nurse navigator. She said once the patients realize they aren’t alone in their diagnosis, they start to encourage one another to make positive changes such as eating better and stopping smoking.

Gena Hoskins, of Fairfield Twp., who works as a medical assistant in Wagoner’s office, said after getting her own heart failure diagnosis last December, she found herself in the same position as the patients she helps.

“I became a patient of the doctors I work for,” Hoskins said, who started attending shared medical appointments a week after leaving the hospital.

“It’s intensive information in a group setting and people talk about their feelings and experiences,” Hoskins said. “That’s the beauty of it; everyone sharing experiences. It’s invaluable.”

Hoskins said she found the discussion on diet to be especially helpful due to new restrictions on fluid and sodium intake after a heart failure diagnosis.

“The intense education at a critical time has helped me; you are using what you have learned a lot because it’s so vital,” Hoskins said.

Wagoner said she and her heart failure team are working to expand the heart failure SMAs to other Mercy Health hospitals. She said the shared medical visit model aims to improve quality and patient outcomes and reduce hospital readmissions.

“It’s a cost and care issue,” Wagoner said, as hospitals with high 30-day readmission rates for heart failure patients can be fined by the Centers for Medicare & Medicaid Services.

Wagoner said since October she’s only had one patient readmitted to the hospital, out of the 50 who attended shared medical appointments.

Officials at Fort Hamilton Hospital, Atrium Medical Center and Cincinnati Children’s Hospital Medical Center in Liberty Twp. said their physicians do not offer SMAs yet. A handful of TriHealth-owned physician offices hold shared visits for limited chronic conditions.

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