Strength in Numbers: Implementing a Group Weight Loss Program Jill Sadoski, MD, MBA Erin Hendriks, MD Wayne State University – Family Medicine

Purpose Group visits allow more time for education and relationship building in comparison to an individual visit with a physician Ideal setting for patient’s to share experiences with other individuals who are having similar struggles Allow health care providers to offer better access to care and resources at a lower cost Group visits have been shown to improve quality of care and patient satisfaction, which is an important element to consider with reimbursements rates being tied to patient satisfaction scores. Jaber,R., Braksmajer, A., and Trilling, J.S. (2006). Group Visits: A Qualitative Review of Current Research. Journal of the American Board of Family Medicine, 19(3): 276-290.

Objectives Provide information on how to develop and conduct group visits in a primary care setting Describe the benefits of a multidisciplinary approach to group weight loss visits Identify barriers to initiating group visits Model a mindful eating exercise

Advantages to Group Visits Improved patient satisfaction Patient-centered Peer support and shared experiences Maximizes educational time Billable service Improved clinical outcomes Jaber,R., Braksmajer, A., and Trilling, J.S. (2006). Group Visits: A Qualitative Review of Current Research. Journal of the American Board of Family Medicine, 19(3): 276-290.

Developing a Group Visit 3 months prior to the first session: Develop an agenda for each of the sessions Develop an introduction and invitation letter Determine mode for measuring success Invite guest speakers Identify and invite potential participants roughly one month prior to start date

Developing a Group Visit Individual visit scheduled in the month prior to the start of the group Reminder calls one week prior to the session so participants knew when to arrive and what to expect

Developing a Group Visit One week prior to the first session, gather educational materials and handouts to give patients at the first session: Patient educational handouts Journal Name Tag Information regarding MyFitnessPal application Demonstration

Group Visit Team Clinical psychologist Exercise physiologist Resident and attending physician Patients

Group Visit Agenda 60-minute sessions that occurred every 2 weeks for a total of 6 sessions in a 12-week period. 3:45pm - 4:00pm: One-on-one visit with a physician 4:00pm – 4:10pm: Discuss successes and challenges from the previous 2 weeks

Group Visit Agenda 4:10pm – 4:40pm: Discussion led by either a member of our psychology team or exercise physiology team 4:40pm – 5:00pm: Physician led discussion regarding medical aspects weight management and health lifestyle. Psychology team would use this time to conduct exercises and instruction centered on the psychological aspects of weight management. Exercise physiology team would use this time to discuss healthy eating habits and various aspects of exercise (aerobic, strength, etc.)

Outline Session 1: Introduction and Surveys (PHQ-4 and Multidimensional Health Profile) Group Rules Confidentiality Attendance and participation Supportive and nonjudgmental environment Goals and Overview of the Group Visit Goal Setting Beverages My Fitness Pal

Surveys

Surveys

Outline Session 2: Successes and Challenges over the previous 2 weeks Mindful Eating Exercise Starting an exercise program Map of Crittenton Walk Develop a walking group

Outline Session 3: Successes and Challenges over the previous 2 weeks Triggers Portion sizes, Calories, and Number of servings

Outline Session 4: Successes and Challenges over the previous 2 weeks Exercise Aerobic vs. Anaerobic exercise Discuss Fad Diets

Outline Session 5: Successes and Challenges over the previous 2 weeks Further discussion of exercises (anything not covered in pervious session) Motivational support given Behavioral change and the role that emotions play in how we eat Review Goals (determined in Session 1) and discuss progress

Outline Session 6: Successes and Challenges over the previous 2 weeks Body Composition Discuss relapse prevention Exit surveys

Insurance Coverage For Medicare beneficiaries with obesity CMS covers: One face-to-face visit every week for the first month; One face-to-face visit every other week for months 2-6; One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement during the first six months. Variable coverage for Medicaid managed plans and Private Insurance

Billing and Coding Can use appropriate E+M code as long as one-on-one time is incorporated into each visit. Code 99078 describes physician education services in a group. Need to contact payer to verify coverage. Contact payer directly to determine if services of nutritionist and behavioral health specialists can be directly billed by the non-physician provider.

Barriers Group Numbers and Regular attendance Time consuming at first Rolling admission developed to allow for missed sessions and increased participation Time consuming at first Loaded all materials onto a central site which could be printed at the start of each visit Frustration with not always seeing the desired results. Space

Let’s Try It! Demonstration of individual “check in” at the start of group Demonstration of a mindful eating exercise

Mindful Eating Exercise

My Fitness Pal

My Fitness Pal

My Fitness Pal

Questions?