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Will Obamacare make you attend group doctor appointments?

You may have heard the Affordable Care Act (ACA), also known as Obamacare will force you into group doctor visits -- but don't panic. Experts say shared appointments are voluntary, patients usually like them and they can help improve the quality of health care.

"The goal is to make [the appointment] a one-stop-shopping experience," says Edward Noffsinger, a psychologist who develops models for group visits and shows health care providers how to implement them.

doctor appointmentIn the mid-'90s, Noffsinger got the idea for group visits when he got very sick, had a stroke and wasn't happy with his medical care. He says he made a wish list that included the ability to get an appointment any week, more time with his doctor and the chance to get support from other patients.

Though group visits have been around for a while, most doctors still offer only one-on-one appointments. According to the American Academy of Family Physicians (AAFP), fewer than 12 percent of AAFP members surveyed in 2012 offer group appointments.

What are group medical appointments?

Group medical appointments involve a group of patients meeting with their doctor and other health care providers for a follow-up visit or management of a chronic condition, according to the AAFP.

These appointments usually include about six to 13 patients and can last up to two hours, Noffsinger says. Here's how they typically work.

• Participating patients get a packet in the mail. This includes educational health information, a questionnaire and orders for lab tests to be done before the visit.
• While a sore throat or swollen ankle can be checked in a group setting, an exam that requires the patient to undress will be private. The doctor uses multiple exam rooms to efficiently examine each patient. A trained medical assistant follows the doctor, making notes in patient charts. Afterward, patients gather in a group meeting room with the doctor and other providers.
• If no physical exam is needed -- for example, a follow-up visit for a chronic condition such as diabetes -- patients meet as a group from the start. A nurse takes vital signs and gives immunizations, if necessary. A behaviorist, usually a social worker or psychologist, writes down patient questions and concerns. The doctor arrives and goes from patient to patient, covering exam findings, medical issues and concerns. • The documenter makes notes in the patient chart, and the doctor briefly checks them to make sure the information is accurate and complete.
• Through discussion facilitated by the doctor and other professionals, patients often answer questions, give advice, share experiences and provide emotional support to each other.
• The session ends about 10 minutes early so the doctor can answer private questions or conduct a quick exam, if necessary, if one wasn't done initially. For example, if a woman mentions during the session that she had found a lump in her breast that morning, the doctor could check that in a private exam room, Noffsinger says.

The AAFP states that group visits are "a proven, effective method for enhancing a patient's self care of chronic conditions, increasing patient satisfaction and improving outcomes."

How doctors organize group medical appointments

Group medical appointments can be used for primary or specialist care and typically can be organized in three ways:

1. By condition.

The group would consist of patients who all share a certain illness or condition, such as pregnancy, the flu, diabetes, high blood pressure, heart disease or cancer. Patients often provide good role models for each other and learn things they wouldn't in a one-on-one appointment, says Dr. Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians. "Patients share solutions together," he says, adding that the doctor makes sure that information is correct.

2. By characteristics.

A primary care doctor or internist with a practice focused on female patients, for example, could offer group visits based on age, Noffsinger says. One group might be for women age 18 to 35, another for women 35 to 50, then 50 to 65 and 65 and older, he says, adding, "The patients would have a lot in common."

3. A mixed group.

And, finally, a doctor could offer a group visit for a variety of patients with various complaints -- for example, migraine headaches, high cholesterol and diabetes. "It seems counterintuitive, but it works beautifully," Noffsinger says. That’s because, he says, patients learn from and support each other even when a different ailment brought each one to the doctor.

But shared medical appointments don't work for highly contagious illnesses like bird flu or for medical emergencies like chest pains that might signal a heart attack.

"That's (when you call) 911 to the ER," Noffsinger says.

Will Obamacare force you into group appointments?

It's a myth that Obamacare will push patients into group appointments, Noffsinger says. "But, group medical appointments do have a lot to offer the Affordable Care Act," he says.

That's because about 25 million Americans are expected to get health insurance in the next 10 years as a result of Obamacare, according to projections by the Congressional Budget Office -- and a study by the Mongan Institute for Health Policy found that many of them might have trouble finding a primary care doctor who's accepting new patients.

But properly run group appointments allow a doctor to see double or triple the number of patients in the same amount of time, Noffsinger says. Group visits are a "win-win-win," Shahady says, because they benefit patients, doctors and the medical system as a whole.

The ACA's emphasis on improved outcomes and value could help change the way doctors are paid for patient care -- and that could make more doctors willing to offer group appointments, Shahady says.

In order for group visits to truly take off, he says, insurance companies would need to shift toward reimbursing doctors for meeting goals and getting patients healthier rather than strictly for treating a condition or illness – which is an ultimate goal of the ACA. "If I were reimbursed based on value, I could change how I care for people," he says.

However, experts say there will always be patients who don't like the group visit format -- and, if more patients who do like it move toward shared appointments, that will leave more one-on-one appointment slots for others.

"Group visits are absolutely not for everybody," Shahady says.

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