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About SMAs

Why shared medical appointments?

As a healthcare provider, you are always looking for innovative ways to improve your patients’ health. Shared medical appointments (SMAs), also called group visits, do just that. Shared medical appointments offer the potential to transform the way medical office visits are delivered. They work for a wide variety of specialties and medical conditions. Some of the demonstrated benefits include:

  • Better patient access
  • Higher provider satisfaction
  • Improved efficiency and physician productivity
  • Greater patient satisfaction, engagement, and adherence

Dr. Edward Noffsinger developed the SMA concept in the 1990s. Some of the pioneers of the SMA model include:

  • Harvard Vanguard
  • Cleveland Clinic
  • Dartmouth Hitchcock
  • Kaiser
  • Veterans Health Administration

In November 2011, Harvard Vanguard and Atrius Health sponsored the first national symposium on SMAs. More than 200 people representing more than 150 healthcare organizations attended the conference.

So… What IS a SMA?

A SMA is a medical appointment where several patients are seen at the same time in a supportive group setting. During a shared medical appointment the physician tends to the medical needs of each patient one by one. This is done in front of the whole group of patients, with the support of a whole healthcare team. Instead of only spending 15 minutes with one patient, the team spends 90 minutes with 8 to 14 patients.

Shared medical appointment One-on-one appointment
8-14 patients seen at the same time Patients seen one at a time
90 minutes with the physician and team Usually less than 15 minutes with the physician
Exam done in a group or alone Exam done alone
A whole healthcare team Doctor and nurse
Group social support Patient often feels isolated or alone
Provider-to-patient and patient-to-patient education Provider-to-patient education
Goal setting with the team each appointment Occasional goal setting with physician or nurse
Taking patient history Taking patient history
Diagnosing Diagnosing
Prescribing medication Prescribing medication

Exams may be conducted in private if the doctor or patient prefers. Everything else happens in the group so that all of the patients benefit from the interaction. Shared medical appointments do not replace individual appointments. Shared medical appointments work well with patients that have similar conditions, issues, or needs. They are also quite effective for all the patients of a particular physician with multiple conditions. This setting allows patients to relate to each other, which in turn improves social support, role modeling, and education within the group.

Shared medical appointments are a bridge between traditional fee-for-service and accountable care or medical home models. They can also facilitate shared decision-making. Common concerns regarding confidentiality are readily addressed. Once skeptical providers witness a SMA in action, or patients participate in one, the response is overwhelmingly positive.

Who is the SMA team?

The team of healthcare professionals consists of:

  • Physician
  • Medical assistant or nurse
  • Facilitator
  • Documenter
  • Scheduler

One of the most unique and influential team members is the facilitator. The facilitator may be a behaviorist, social worker, health coach or nurse. This person undergoes special training to act as the overall coordinator throughout the appointment. S/he helps patients set and reach their health goals and facilitates the group.

Who goes to a SMA?

Shared medical appointments can be for follow-up or routine care. SMAs work well for many different types of patients. Patients that may not be a good fit for SMAs are:

  • Patients that speak a different language than the rest of the group
  • Patients with a serious infectious disease
  • Patients with severe hearing impairments
  • Patients that with Alzheimer’s other forms of dementia
  • Emergency medical concerns for which one should call 911
  • Patients needing a complex medical procedure