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

2. 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):

3. 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

4. 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):

5. 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

6. 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

7. 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

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

9. 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

10. 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.)

11. 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

12. Surveys

13. Surveys

14. 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

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

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

17. 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

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

19. 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

20. Billing and Coding
Can use appropriate E+M code as long as one-on-one time is incorporated into each visit.
Code 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.

21. 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

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

23. Mindful Eating Exercise

24. My Fitness Pal

25. My Fitness Pal

26. My Fitness Pal

27. Questions?