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Policy Blog: Innovation and Interaction: Shared Medical Appointments

Eugene_Rhee_MD_MBAEUGENE RHEE, MD MBA

There is a classic equation in the business of innovation:

VALUE OF INNOVATION
= (Quality + Service)
÷ Cost


So why is this so pertinent to urologists who read this? We chose this specialty for the innovation we recognized as medical students. You have heard much over the last several years about the Affordable Care Act. There is much fatigue over the worry and anxiety about this, and I urge you to look at this as a real opportunity to bring the innovative talent we all possess as urologists to the surface and apply real and strategic solutions to healthcare delivery.

One of those solutions is the Shared Medical Appointment (SMA). The SMA provides an innovative and interactive approach to office-based urologic care that brings patients with common urologic needs together with the healthcare provider. While an individual appointment typically lasts 15 minutes, an SMA is 90 minutes long, allowing participants to spend more time together. The provider has the flexibility with time, what is presented and how it is presented. As well, this only has to be presented once and in a dynamic, engaging way.

Staffing for an SMA can be pretty basic, so the costs are minimal as you are scaling the labor. In a way, Henry Ford did this in his automobile factory working in parallel fashion rather than serially. You can have your ancillary staff do this as well. The amazing thing about the SMA is that the patients absolutely love this setting.

SMAs are legal and are reimbursed by private insurance carriers as well as Medicare as if you are doing individual billing (as long as you meet the coding criteria). Who are perfect patients for the SMA? That should be easy to guess based on how simple a concept this is: erectile dysfunction, return prostate cancer, metabolic stones, frequent UTIs and cystitis are all good topics to address in an SMA. Even procedure-based appointments like vasectomy and most interestingly, percutaneous tibial nerve stimulation (PTNS), can be conducted in this setting.

It’s simple in concept but you must understand that the execution requires preparation. Here are some pearls to get you started:

  1. start small and simple
  2. find champions in the staff carefully
  3. use electronic medical records (EMR) templates
  4. schedule regularly (e.g., every third Wednesday).

The AUA Office of Practice Management will be presenting the concept of the SMA during the 2013 Annual Meeting in San Diego. On Sunday, from 1-3pm, join us for an Instructional Course where we will present video segments outlining the SMA.

See you soon in my beautiful hometown – America’s Finest City – San Diego, California.

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