MIDLIFE SHARED

MEDICAL APPOINTMENTS

Work Smarter – Not Harder

 History of SMA’s
Dr. Noffsinger, Kaiser California
– A way to streamline access to care
– Designed specifically for the busy practitioner
– Originally focused on primary care physicians
– Varied applications
Same Day Appointments
Educational Sessions
Substitute for Phone Discussions
General vs. Gender, Age, Disease Based
 Noffsinger’s Work
One 90 min group appointment late in the
workday
Accept All Takers with no limit to age,
gender, symptoms
Eliminate complex and new patients
Requires Medical Assistant, Group
Therapist, Provider, Receptionist, Scribe
Midlife Women’s Health Application
Pre-screening
– Pre-visit screening and laboratory studies with
results available at visit
– Age, Gender Parameters
– Problem/Question list submitted prior
– Eliminate complex problems

Requires 2 Medical Assistants/RN, Scribe

 Basic Flow
PPB (Pap, Pelvic, Breast Exam –
Code#________ Basic CMS
reimbursement available – can be done in
6 minutes, if no counseling performed
Most of time of PPB Visit is spent
counseling regarding midlife issues
Screening Tests ordered at visit usually
scheduled after the visit, and then require
discussion of results 2-4 weeks later.
 Midlife SMA

What if we combined education,

counseling, and discussion of results
in one 90 min session, and grouped 10-
12 patients together in one session?
 ANSWER:
We could charge code #______ X 10 for a one
hour session ($1___. )
We would be less likely to skip or miss an issue
due to provider boredom
Patient satisfaction would generally improve,
since patients (i.e., women) generally like the
idea of group process and having their issues
heard unhurriedly
We would save unreimbursed time on the phone
discussing test results and their significance
 What About HIPAA?
Simple forms have been developed for
participants to sign before each session to
request that “What happens here, stays
here.”
Patients who don’t work well in groups or
have highly personal issues they don’t
wish to discuss can be seen on an
individual basis – You really don’t want
them in a group setting, anyway
 The BWH Experience
Since 2005, BWH Currier has been developing
programs for Midlife and DEXA result SMAs.
Most of the experience has been positive, with
many patients writing notes of appreciation, and
even deciding to meet with the same group next
year.
Surprisingly, they seem to keep coming back even
though the process/discussion is similar each
year. They say they learn more each time.
 Financials
$1,600
$1,400
$1,200
$1,000
$800 5 pts
10 pts
$600
12 pts
$400
$200
$0
Midlife DEXA
PPB Codes Codes
 Patient Satisfaction
Quotes from Notes from Patients

99% Office Pt Satisfaction

 Time Study
(Time is Money)
Provider Time: 2 hours
MA Time: 2 hours
RN Prep Time: 1 hour/patient
– Scheduling Tests
– Chart Prep
– Patient Contact
– Clinical Time
– Scribe and Charting
– Rx Prep and Writing
 General Flow of Midlife SMA at
Currier Drive BWH
Receptionists
Patient calling for routine PPB
Invitation to SMA with positive slant
RN
Orders routine screening tests
Rules out complex problems
Invites questions
Lists issues
Notes meds, history, problems
Preps chart prior to visit
Gathers test results
Writes routine prescriptions
Places Problem List on White Board in conference area
 Day of Visit
Patients Roomed By MA
VS, Weight, Height
PPB performed by Provider (6 minute goal)
Abnormals given appointment for additional
problem visit or additional testing
All 10 Patients Escorted to Conference Area
Conference and Discussion (40-60 min.)
First 5 Patients Check out, Last 5 are roomed for
exams.
Each woman is there for a little over 1 hour.
 Conference Proceedings
Group Process Explained
Confidentiality Agreement
Introductions – Name Tags with First Names Only
Problem List on White Board
Test Results in Folder Marked with Patient Name
Informational Materials in Folders
Calcium, Exercise, Women’s Heart, HRT,
Information in Conference Room
Samples of Calcium, Vitamin D, Vitamins
Brochures on Osteoporosis, Hormones, Bladder Issues,
Mammography
Breast models with lumps to palpate
 Discussion Process
Discussion of Problem List on Board
Sweats/Flushes
Incontinence
Dyspareunia/Loss of Libido
Bone Health
Breast Health
Cardiovascular Health / Lipids
Weight Control
Discussion of Individual Test Results and how to interpret
Discussion of Prevention Techniques
 Finishing Up
Patients desiring new or different Rx
Patients desiring referral to another program
– Women’s Heart
– Metabolic Clinic
– Weight Watchers
– PT / Fitness Center
Charting continuously by Scribe
Encounter forms
Signing of forms, prescriptions, referral
sheets/tests