1. Clinical And Financial Reasons to Offer Group Visits to Your Diabetics Conference on Practice Improvement December 2, 2010 Paul M. Dake, M.D. Office Medical Director McLaren Family Medicine Residency

2. Objectives Relate the history of Group Visits in our office Demonstrate our Group Visit Progress Note Discuss a vignette demonstrating the types of interactions seen during our Group Visits Present a case for offering Diabetes Group Visits in your office Identify a website from which a Diabetes Group Visit Replication Manual may be downloaded

3. Hx of Our Group Visits 2006 AAFP Scientific Assembly First Group Visit was in January, 2007 Constructed a Diabetes Registry Mid-2007 – added a second group 4-8 patients at each visit Visitors interested in duplicating model Who is the most appropriate patient?

4. Group Visit Progress Note Single-page questionnaire (page 1) Objective data (page 2) –Other forms are incorporated into the progress note by reference Summary of Care (Problem List) Medication List Diabetic Care Plan –Physical Examination

5. Group Visit Progress Note (cont.) Assessment (page 2) –Diabetes, Type 1, controlled –Diabetes, Type 1, uncontrolled –Diabetes, Type 2, controlled –Diabetes, Type 2, uncontrolled –Degree of control of blood pressure and dyslipidemia –Other comments on patient’s condition

6. Group Visit Progress Note (cont.) Plan (page 2) –Patient Education discussed/given –Month & year next studies due (and how the results will be conveyed to the patient) HgA1c GFR (part of Basic Metabolic Profile) LDL (Fasting Lipid Profile) Microalbuminuria Diabetic retinal exam –Return visit in …….

7. Group Visit Progress Note (cont.) Back of page 2 of the template… –Coding algorithm, resulting in a more accurate representation of the complexity of our patient population –Decision support tool regarding timing of next studies Diabetes Action Plan – chosen by the patient & negotiated by the patient and the physician

8. VIGNETTE

9. Comparative Economics ‘Traditional’ 1-on-1 patient visits –8 ‘99213’ visits ($73) in 2 hours = $584 –9 ‘99213’ visits ($73) in 2 hours = $657 ‘Group Visit’ model (2-hour visit) –8 ‘99214’ visits ($113) = $904 –7 ‘99214’ visits and 1 ‘99213’ visit = $864

10. Diabetes Group Visit Replication Manual 110+ page booklet Designed to guide the interested clinician through the process of planning and implementing group visits PDF file can be downloaded free of charge at www.gfhc.org, click on ‘Current Programs’, then on ‘Diabetes Group Visit Program’ on left, then scroll down to ‘Additional Resources’, and click on ‘Replication Manual’ www.gfhc.org

11. Review of Objectives Related the history of Group Visits in our office Role of the Greater Flint Health Coalition Demonstrated our Group Visit Progress Note Discussed a vignette demonstrating the types of interactions seen during our Group Visits Presented a case for offering Diabetes Group Visits in your office Group Visit Replication Manual download

12. QUESTIONS? THANK YOU!