Michael Parchman, M.D.
A family physician in San Antonio considered why it was so hard for his patients to have optimal control of their A1C, blood pressure (BP), and cholesterol. He realized that he was trying to pack too much into each visit, and often spent 30–45 minutes providing patient education and support for some patients. He had previously worked in a community health center where group diabetes visits were offered, so he decided to conduct a group visit in his clinic.
The team included the physician and his office staff of two medical assistants, one licensed vocational nurse, three front desk staff, and one lab technician. A local representative from a pharmaceutical company was a certified diabetes educator and volunteered to teach a one-hour class during the group visit. The physician and team members held three planning meetings to prepare for the group visit. These meetings proved to be essential so that team members were prepared and understood their roles and responsibilities.
The team selected a Friday morning three months in advance for the group visit. As patients with diabetes were seen in the clinic over the next three months, those with poor control of A1C, or BP, or cholesterol were invited to attend the group clinic and were given an appointment for that Friday morning.
Each team member was assigned a “station” in each of three exam rooms where measures were obtained for A1C, LDL-cholesterol, and BP, respectively. The team member measured the required value and discussed the results with the patient. Each patient was given a station visit schedule, ending with a “medication station,” where the physician reviewed the patient’s medications; reviewed the patient’s A1C, BP, and cholesterol values; and then made appropriate changes to the patient’s medications if necessary.
After visiting all of the stations, the patients gathered in the reception area of the clinic for a one-hour discussion session with the diabetes educator. A healthy light lunch was provided.
A one-page template for documentation of the group visit was developed for billing purposes. Each staff member completed one portion of the template. The physician reviewed the documentation and completed the template during the one-on-one medication review with each patient. The visit with the doctor was billed using the usual CPT codes for primary care visits: 99213 or 99214.
Of the 20 patients invited, 17 attended. Interviews with the physician and office staff after the group visit revealed that the staff felt more involved in patient care and more satisfied with their role in the clinic than they had before the group visit. The physician felt more invigorated and was happier with his practice. Both the staff and physician reported improved patient understanding and improvements in patients’ diet, physical activity, and medication-taking behaviors in the months following the group visit. Analysis of data from the charts before and after the group visits revealed declines in mean A1C from 8.5 to 8.0 percent; systolic BP from 142 to 132, and LDL-cholesterol from 124 to 99 mg/dl. Subsequent diabetes group visits were held every six months. The CDE drug representative continued to volunteer and teach a class during the group visits. The physician now also holds group clinic visits for patients with asthma.