The ABCs of Group Visits by Edward B. Noffsinger

Author:Edward B. Noffsinger
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

“This Sounds Like Managed Care Cost-Cutting, not Increased Quality of Care”

When they first hear about DIGMAs and PSMAs, physicians sometimes express concern that group visits represent one more cost-cutting measure by managed care organizations justifying the overworking and understaffing of physicians. Some, especially during the early years of these models, went so far as to say that SMAs represent “meat market care” or “managed care at its worst.” The argument here is that group visits treat people like cattle by herding them into a group instead of providing them with personalized, individual care.

It is true that well-run DIGMAs and PSMAs can significantly leverage existing resources to dramatically increase physician efficiency, but these productivity gains are serendipitous concomitants to my original goals of providing patients with accessible, high quality care. The real reason I originally developed the DIGMA and PSMA models was to enhance accessibility as well as the quality of care and healing experience that patients (including myself) receive. Looked at from a different perspective, DIGMAs and PSMAs actually provide a more expensive form of medical care delivery, one that includes other patients, involves a multidisciplinary care team, and better attends to mind as well as body needs. These SMA models deliver medical care with a warm, personal touch that allows physicians to interact with their patients in ways that short, rushed individual visits simply do not permit. Perhaps this is why patients sometimes refer to SMAs as “Dr. Welby care,” and why one physician told me that, in his oncology DIGMA, he was finally able to deliver the quality of medical care that he originally envisioned being able to provide when he was in medical school. In addition to improved access and more time with their own provider, DIGMAs and PSMAs offer patients numerous informational, patient education, and quality of care benefits (See Fig. 3.1).

Fig. 3.1Parents share their questions and concerns in a 1-month wellness visit PSMA. Properly run DIGMAs and PSMAs offer patients many quality, educational, and support benefits—plus prompt access and more time with their own provider. (Courtesy of Dr. Connie Wall-Haas, Certified Pediatric Nurse Practitioner, Harvard Vanguard Medical Associates, an Affiliate of Atrius Health, Chelmsford, MA)

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