Massachusetts, the proud model for likely Obama-Kennedy reform, is trying a new answer for the problem of a severe doctor shortage: group appointments.
Deluged with demand from newly insured patients, doctors have no room on their appointment schedules for all the new patients. At Holyoke Medical Center, it takes 4 months to get an appointment. A patient with chronic Lyme disease can’t find a single primary physician in three towns who will accept a new patient, so she goes to the emergency room, recounting her history to a different intake nurse, for all medical needs, including her regular prescriptions.
The Massachusetts universal coverage law required 440,000 more people to buy insurance or sign up with expanded Medicaid, and every one of them has to have a primary doctor in order to get into the system. Yet in the past year, 18 primary physicians have left the Amherst area (All Things Considered). , NPR 11/20/08
Harvard Vanguard Medical Associates now features “shared medical appointments.” Dr. Gene Lindsey, reputedly HVMA’s best cardiologist, sees all his patients in groups. HGMA plans to offer group appointments with 50 physicians and nurse practitioners (Liz Kowalcyzk, “The Doctor Will See All of You Now,” Boston Globe 11/30/08).
One group appointment, featured in a Boston Globe video showed nine patients seated in folding chairs around a table with snacks. Dr. Erickson shook hands with each of them and examined them one by one, discussing their medical details aloud. The video showed him listening to and percussing chests through clothing.
The appointment lasted 90 minutes. This is said to reduce doctor and patient dissatisfaction about feeling rushed during a 15 to 20 minute visit. Patients are said to be pleased that they are spending much more time in the room with the doctor. Nearly 80% said they would schedule future group appointments.
Patients are said to benefit from hearing others describe their symptoms and ask questions.
“People came to me with similar complaints and I had these canned speeches,” Erickson explained.
Patients have to sign a form promising not to reveal information they learn about other patients.
The doctor can bill for nine individual visits for the time period in which he previously could have seen only four to six individual patients. He can thus increase his productivity without having to work more.
There were 58 comments posted by Dec 1, and not all patients were pleased.
One wrote: “Nice business model if you can achieve it. Convince state lawmakers to require everyone to ‘get’ medical insurance which is really privatized medical taxation. Now convince the check-writing insuracrats that it’s justified to pay you the same for less service. Sorry, sharing the appointment with others is less service. This is little different than a taxi driver charging each of five passengers the same fare to go from location A to destination B. At least the taxi driver doesn’t provide less service.”
Another wrote: “There aren’t enough doctors because doctors are required to practice high-speed cookbook medicine…. So the answer is to speed it up more so patients can listen to canned speeches together?”
Other descriptions: “Third-world standard of care: many people being seen by a doctor at the same time, sharing…germs.” A “commoditization” of human beings. Having to listen to all the other patients is a “tax on people’s time.”
One idealist thinks it’s just what we need: “I think that as a nation we need to move AWAY from rampant individualism toward a system that embracees shared responsibility in a community. You are more likely to follow those pesky lifestyle recommendations if you feel like you’ll not only be letting down yourself and your doctor, but also your community.”
The appointments are “voluntary”—although possibly the only kind available for months. They are focused on health care, not sickness care: “1) education, 2) individual goals, expectations, and treatment plans, 3) self-management strategies, 4) developing a personal action plan.
Obama needs to look no farther than Massachusetts for a model, writes Jeremy Smerd. One small problem: Massachusetts knew it was not addressing the cost issue. Annual state spending could top $1 billion by 2009 (Workforce Management). 11/11/08
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