4. Core 4 - Medical Visit
Diabetes-focused individual medical visits occur during the group visits. The medical visit is a key feature that distinguishes group visits from group education where medical care is not usually provided. The goal of the medical visit is to provide patients with their recommended diabetes medical care. This may include lab orders, screenings for comorbidities and behavioral health, immunizations, refills, and referrals. There are some key decisions to make when planning your medical visit.
How does a medical visit fit into a group visit?
The medical visit focuses on diabetes and may be brief, around 5-10 minutes. The medical visit provides time for patients to ask providers questions in private regarding their diabetes management and care.
When does the medical visit happen?
Medical visits can happen at the same time as group education, before group, or after. Often times, a medical provider will ask a patient to step out of the group session and see the patient 1:1 in a private clinic room or private section of the larger room.
Will the medical visit be conducted at each group visit?
Medical visits may not be needed for all patients at each group session, but most patients would benefit from a brief visit where their vitals are checked, processes of care reviewed, and medications refilled or titrated if needed.
What is included in the medical visit?
The goal of the visit is to help patients receive recommended diabetes care. This brief, focused medical visit can include:
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- Review of vital signs
- Medication titration and refills
- Lab orders for routine labs
- Referrals to other providers or services such as podiatry, optometry, dental, behavioral health
- Screenings for comorbidities
- Screenings for emotional health
- Immunizations
- Limited physical exam
- Support and coaching
- Review of goals set in the group session
What are some of the logistical elements to consider?
Time / Scheduling
- The brief visit does not provide much time to address concerns not related to diabetes. A plan for follow up on other concerns or urgent medical care should also be in place.
- Patients may not want to leave the educational session for the individual visit. Assessing patient preference of timing of the 5-10 minute clinical encounter may be important or at least making sure that patients are seen at different times each group visit.
- You might consider offering patients the opportunity to have individual visits with other providers (e.g., pharmacists, dieticians, behavioral health) but these visits may need to be brief so patients are not removed from the group session for an extensive period of time.
Billing
- Some health centers decide to bill insurance for the individual medical visits that occur during the group visit session.
- Discuss your plans with the billing specialists at your clinic to determine what key elements are needed in charting and the types of billing options that are available.
Providers
- Enrolling patients from multiple provider panels requires coordination and collaboration. Some primary care clinicians may be hesitant to have another provider titrate their patients’ medications or provide medical treatments. Open communication between the group visit team and the patients’ primary care providers from the beginning is key.
- In addition to individual medical exams, providers may also be involved in the group education session (e.g., discussion about complications, Q&A about medications). One of the benefits of group visits for patients is extended time with the provider overall, and patients can learn from hearing the answers to questions that other patients may ask.
- The group sessions are also a great opportunity to introduce patients to other providers at the clinic, such as podiatry, optometry, or behavioral health. Then if patients are referred to them, they will have already met the provider.
“I enjoyed the group sessions. The staff and guest speakers were very helpful. I have gotten on track with my meds, checking my feet, I have had a dental, podiatry and eye appointment. I learned so much about how the whole body plays a part in managing and controlling diabetes and the impact it has on my overall health.”