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Shared medical appointments (SMAs) are also called group visits, group medical appointments, and group clinics. Various SMA models have been used for many years to optimize patient-centered medical care. John Scott, MD (a JasterHealth consultant), Sharon Schindler Rising, CNM, MSN, and Ed Noffsinger, PhD, independently developed the 4 main models. Dr. Scott created the CHCC (cooperative health care clinic) for geriatric patients, Sharon Rising created Centering Pregnancy and Parenting, and Dr. Noffsinger created the DIGMA (drop-in group medical appointment) and the physicals SMA models. The Centering model has received many awards and recognition for its innovative and effective health care delivery, and is expanding to include the whole lifecycle (e.g. chronic disease, well adolescent and adult, menopause, and geriatrics care).

The advent of some SMAs occurred due to frustration with the medical care delivery system. Dr. Scott realized he could not take care of chronically ill seniors with complex health concerns in a 15-minute office visit. His patients needed more time to have their concerns and questions answered, and he needed extra time to provide quality medical care and avoid preventable and costly complications of aging and disease. For Dr. Noffsinger, he was a patient at the same time he was a psychologist. He drove a long distance to see his physician, then waited and waited and waited, in order to finally see his doctor. Once he waited 3 hours, for a typical short and rushed office visit, and then drove the long distance home with several questions that he had forgotten to ask his physician.

SMAs resolve much of the dissatisfaction that commonly occurs with medical care delivery. SMAs typically bring together 8-12 patients, their medical provider, and a health professional/guest educator (to help direct the group) for 90 minutes of relaxed, interactive, efficient, educational, effective and empowering medical care. Increasingly, specialists are asked to provide primary care, thus SMAs are an ideal way to increase availability for specialty procedures and surgeries.

Guest Educators

• Nutrition specialist
• Diabetes educator
• Podiatrist
• Exercise specialist
• Pharmacist
• Social worker

Elements of Shared Medical Appointments

• Socializing
• Education
• Medical care
• Questions/answers
• Participant feedback about future educational sessions

SMAs are not classes or support groups, although participants will feel supported and improve knowledge of health promotion and disease management. Participants commonly mention that they:

• Heard questions that they had never thought to ask.
• Ask all of their questions.
• Learned new information.
• Prefer SMAs to individual visits with their medical provider.

A unique aspect of SMAs is the opportunity for participants to learn self-management skills. Dr. Scott reports that in 1 typical month he received 52 messages from patients that saw him in individual visits, and only 7 messages from those patients that attended his geriatric group. Participants typically form an informal support network, which improves compliance with care plans and goals. This team approach to living with chronic disease aids the medical provider, who uncommonly has experienced a chronic disease.

Satisfaction by participants and medical providers improves with SMAs, along with improved quality of medical care. Studies show better outcomes, such as:

• Fewer hospitalizations and emergency room visits in geriatric patients.¹
• Superior quality of life, and disease control, knowledge, and self-management for diabetes patients.²
• Less preterm births with improved breastfeeding success.³
• Cost savings¹ and/or increased productivity.

SMAs improve timely access to both acute and chronic medical care, and compliance with chronic disease and preventive medicine guidelines. The reality of pay for performance, and the necessity to bridge the quality chasm in health care,⁴ makes SMAs a valuable tool to achieve quality goals.

Medical providers utilizing SMAs have the opportunity to provide education about proper nutrition, sustainable exercise, and effective weight loss that is not typically covered by insurance (when provided in a stand-alone medical appointment). In addition, patients are often willing to pay out-of-pocket for SMAs devoted to education and prevention, which would not otherwise be affordable without insurance reimbursement. Focus on health, not illness, by optimizing the time leveraged through shared medical appointments.

SMAs are vital for the provision of patient-centered care, “the medical home”, and the idealized medical practice. Even the “micropractice” can utilize SMAs with proper planning. While the Future of Family Medicine report⁵ included SMAs as a key component, the Centers for Medicare & Medicaid Services clearly approved SMAs as reimbursable medical care.⁶

Revitalize medical practice with SMAs. Many doctors who left medical practice for administrative roles often continued their established SMAs. Dr. Scott asserts that “Groups are pure joy.” Is there joy in your day to day reality of medical care? In the days of physician burnout, nursing shortages, and rising health care costs, SMAs are an encouraging beacon. JasterHealth brings SMAs (and their variations) directly to you or your organization. Working happier, not just smarter, and certainly not harder, is possible with proper utilization of SMAs.