Doctors Implement Group Appointments to Save Money, Time

To address the "financial rigors imposed by managed care," some Sacramento-area physicians are scheduling appointments with patients in groups, instead of traditional "one on one" appointments, the Sacramento Bee reports. Under the system, patients with similar ailments can choose to meet in a group with a doctor and a therapist to receive advice. Weight, blood pressure and other lab work are still done individually, and treatments are tailored to each patient. With managed care companies paying a flat monthly fee on a per patient basis, physicians say that the group system allows them to "achieve economies of scale lacking in one-on-one visits." In addition, physicians maintain that groups allow them to satisfy patient demands for "fast and frequent access to care." Further, some physicians say that group dynamics may "pressure" patients to comply with doctors' orders, thus improving health and reducing costly hospitalizations and repeat visits. For three years, Kaiser Permanente's office in Rancho Cordova has been offering a diabetes group, and Sutter Health and Woodland Healthcare also have incorporated groups into their practices.

To date, there have been no studies to show if group visits improve patient care or save doctors' time, the Bee reports. There are no estimates on how many group appointments are conducted and no standards for billing insurers for the sessions. In addition, some consumer advocates have "question[ed] the medical necessity" of group sessions and are concerned about patient privacy. In group appointments, patients typically sign confidentiality waivers similar to those used in therapy groups in order to participate in the sessions. Jamie Court, executive director of the Foundation for Taxpayers and Consumer Rights, said, "It's certainly in the financial interest of doctors and HMOs to have group appointments because it can push patients toward a standardized treatment, but it's a terrible violation of patient privacy." However, Dr. Thomas Atkins, CMO for Sutter Medical Foundation's group practice, said, "For years we've been trying to make the system work better with all the money drained out. The cost pressures are not going away. We have to change how we deliver care, and groups are a way to do this" (Rapaport, Sacramento Bee, 2/8).