Noffsinger, author of Running Group Visits in Your Practice, decided that if he got better (which he did), he'd help others in his shoes. He came up with three wishes he'd had when receiving care: better access to his physician in a relaxed environment with other patients who could empathize (so he would not have to burden family and friends). What evolved were shared medical appointments. "The story is actually quite compelling," says Zeev Neuwirth, MD, formerly of the multi-specialty group Harvard Vanguard Medical Associates, where he led shared medical appointments for three years. He is currently chief medical officer and senior vice president of the physician services group at Carolinas HealthCare System, based in Charlotte, NC, an integrated delivery network composed of 33 hospitals and 650 healthcare locations. "This approach was actually created by a patient for patients. That's really critical to understand."
For Neuwirth, it represented a model that treated each patient as an individual, not as a disease or a problem. "Here's a way that we could actually create better-quality care and what I felt would be more respectful and dignified care," he says, "and actually do it in a way that's cost-effective."
He saw such great potential in shared medical appointments that he partnered with Noffsinger to implement them at Harvard Vanguard in specialties as varied as neurology and dermatology, pediatrics and pain management. Today, 10 practices within Harvard Vanguard offer 26 shared medical appointments.
Though Noffsinger says he hasn't yet seen a specialty for which the group-visit approach doesn't work, Neuwirth is slightly more prudent: "In my experience, and again, I have much less experience than Noffsinger, I've observed that they work better in certain situations than others," he says. "For chronic conditions like diabetes, rheumatologic conditions, as well as pediatrics, geriatrics, and obstetrics, they work exceptionally well."
Peter Cheng, MD, AGSF, a geriatrician with Sutter Health's Palo Alto (Calif.) Medical Foundation, has recently started what his team calls the successful aging shared medical appointment. It allows patients 65 and older to focus on "mind, body, and soul" aspects of aging—or put more bluntly, it allows doctors to check the dementia, fall, and depression risk of these patients.
"Geriatricians have always looked for new ways of taking care of older people," Cheng says. "We've always wanted to find ways of creating something that would be of value to the healthcare system, to primary care partners, and also to patients and their families. The way we designed this, we wanted to focus on screening for three high-impact diagnoses in this very high-growth patient segment." The nearly one-year-old program grew from a desire to provide great care for these specialized patients and to use the physician's time effectively. Cheng says it's the time of week he most enjoys.