Massachusetts resorts to group visits with the doctor

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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22 thoughts on “Massachusetts resorts to group visits with the doctor

  1. What happened to medical privacy? What has happened to the HIPPAA regulations in these group appointments? What will the future of these grouped meetings among patients and a single physician bring? Lawsuits with regard to consequences of revealing medical secrets/weaknesses/mortality threats to others who might use such information against another group member? Lies to the physician to avoid such labels? Cessation of honesty between patient and physician? What about the importance of a physical examination in determining diagnosis and treatment? To be performed in front of the “group”? Or will the physician continue to shortchange patients as in HMO medicine by short circuiting the examination, perhaps not even performing it, thus missing many diagnoses and giving inadequate or incorrect treatment, making the shortage of physicians worse because of unaffordable malpractice insurance? Heaven help those of us who remain…..the remnant….how shall we survive such medical standards? Move to another state in all probability….if this does not federalize…..; if it does, hello to another country…..

  2. It is such a shame that our healthcare has deteriorated so much. As a physician, I understand why doctors are leaving their profession. We will be facing more doctor shortage in the future. However, I do not agree with group medical care. Every patient is unique and their needs must be addressed individually. I am in favor of education for patients in groups, but not as a forum for providing medical care.

  3. This sort of de facto rationing is an inevitable consequence of the “Massachusetts plan”. Unfortunately, there are powerful Democrats (such as Senator Baucus of Montana) who wish to impose this system on the rest of America.

    For more information on problems with Massachusetts’ “universal health care” system and some free market alternatives, please see this article from the Fall 2008 issue of The Objective Standard:

    “Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America”

    http://www.theobjectivestandard.com/issues/2008-fall/mandatory-health-insurance.asp

    Paul Hsieh, MD
    Freedom and Individual Rights in Medicine (FIRM):
    http://www.WeStandFIRM.org

  4. I remember group visits being discussed as a possibility at the medical organization I previously worked for before I decided to leave the practice of medicine. Any doctor who participates in this is a quack. How do you dictate the notes and keep the patients separate (or, is it “canned” EMR to the rescue!); does the doctor wash his hands after examining each patient? It’s one thing to have a group discussion about medical issues in general; it’s another thing to pretend you are providing acceptable medical care. The quote above about getting away from “individualism” of the doctor-patient relationship says it all—welcome to communism.

  5. Of course this is not the type of medical care anyone with a modicum of intelligence would want.

    But don’t forget the facts………50% of the population has below average IQ.

    There are always those who appreciate the best. Those skills will always be there. As for the rest….who really cares, anyway?

  6. When I make house calls to my Mexican and Amish patients, it is normally a group affair, with the exception of “female problems”–but (1) this is a family setting, (2) there is usually only one official “patient” present, (3) we retire to a private setting for any necessary disrobing, and (4) I get the impression everyone else is there to support the person who isn’t feeling well.
    If I told them that rather than making 3 house calls, we would meet all parties together at the same time in one location, they would never go for it; the personal touch would be lost.
    Funny, that must have already been missing in Massachusetts…

  7. My dogs have a much better experience at their Veterinarians’ offices. There’s complete privacy. I can get same day imaging services, labs, transfusions, medications, and of course their Veterinarians have long-term personal relationships with them. The Veterinarians are not always finding it necessary to flee one state for another to avoid ethical conflicts, or financial ruin.

    Of course, I pay the Veterinarians myself, with my own money, that I earn. They are not paid with someone else’s money, that has been forcibly taken in taxes and wasted on a giant bureaucracy.
    Boy, I sure am glad that nobody is trying to “reform” Veterinary Medical Care. Of course nobody would “need” to “reform” human medcal care if the government had not interfered in it during those Two Days referred to in William C. Waters’ book “Two Days That Ruined Your Health Care ( And How You Can Provide the Cure).

  8. I am in tandem with Dr Hsieh. In med school Socialized medicine was discussed.
    Left leaning Profs swore it is the definitive answer to heath care delivery.
    Their ideology led them to believe health is a right.

    I experienced the system on fellowships in Canada and England.

    After landing back in the USA , I disembarked the plane and kissed our sacred ground.

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  13. None of you have ever been without insurance for a long time or used a free clinic. If we don’t get some kind of reform only those who are well off will have health care. The rest will be lined up getting 30 second examinations and diagnoses.

    Soon you will see walled communities keeping all the sick people away from them. We will look like a 3rd world country with the elite hiding away from the rest of the population. And their is a good chance, you wont be with them

  14. While you mention Doctor’s leaving……..you leave out the why.

    Why Primary Care Doctors Are Leaving

    Money.
    “Insurance companies (including Medicaid and Medicare) pay less for primary care than for specialist visits.

    And no one pays for the time it takes to fill out paperwork, take surveys for the insurance company”.

    They would be leaving no matter what. And they will still be getting paid from the ‘system’ – just less paper work.

    Keep up the good work at hiding the truth and being a stooge for the insurance industry.

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  18. I think our elected officials need a group examination, beginning with their heads. The first thing I’d look for would be psychosis or drug-induced psychosis. They seem to be suffering from auditory hallucinations. They claim to be hearing the voices of the American people telling them to pass this bill. Or maybe, these people are just mildly retarded and suffer from the below average IQ that Dr. Geller refers to. The next thing I would check would be their skeletons, the ones in their closets, because it seems like many of them are dropping like flies from a disease called bribery (perhaps one of O’Bama’s buddies at big PHARMA will be able to come up with a vaccine for this pandemic, after the bill is passed of course) . I strongly recommend that we hold services this November for those who have succumbed. After all, it’s only the democratic thing to do.

  19. I think our elected officials need a group examination, beginning with their heads. The first thing I’d look for would be psychosis or drug-induced psychosis. They seem to be suffering from auditory hallucinations. They claim to be hearing the voices of the American people telling them to pass this bill. Or maybe, these people are just mildly retarded and suffer from the below average IQ that Dr. Geller refers to. The next thing I would check would be their skeletons, the ones in their closets, because it seems like many of them are dropping like flies from a disease called bribery (perhaps one of Obama’s buddies at big PHARMA will be able to come up with a vaccine for this pandemic, after the bill is passed of course) . I strongly recommend that we hold services this November for those who have succumbed. After all, it’s only the democratic thing to do.

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