WASHINGTON – For practices that offer medication-assisted treatment but perhaps are struggling to balance follow-up appointments with new patient inductions, Leah K. Bauer, MD, has a suggestion: group sessions.
“It’s a lot of fun, and makes my practice more dynamic. It gets me out of the grind of ‘see a patient; write a note; repeat,’ ” Dr. Bauer said at the American Psychiatric Association’s Institute on Psychiatric Services.
Compressing 26.5 hours of individual clinical time into 12 hours of monthly group sessions held twice a week for 90 minutes each, Dr. Bauer said, resulted in an additional $41,000 of revenue annually, with inductions doubling from 8 to 16 per month.
One reason is that despite the sessions taking place in a group setting, she and her staff bill for a series of individual appointments using the CPT code 99212. “It is perfectly legal, and not very recognized,” Dr. Bauer said, noting that the sessions are in a group context, but that she does get to have one-on-one interaction with her patients with the added therapeutic value that peer support brings.
Modeling appropriate behavior is easier in the group setting, she said: “Patients don’t all have to test the same limits.” Instead, they can learn from the interaction of another patient with Dr. Bauer as the therapist. The group setting also helps her deliver more consistent care to all her patients, she said. “I am more conscious of what I am saying.”
A hospitalist and psychiatrist, Dr. Bauer leads group MAT with the help of a clinician cofacilitator who she says reinforces what is being said in the group and acts as a scribe, reducing Dr. Bauer’s administrative burden. “This improves my job satisfaction tremendously,” she said.
Patients sign a “check-in” sheet that also serves as their treatment plan that includes their goals and objectives. It includes the patients’ written self-reflections, what their week was like, and other entries about their mood and struggles with their recovery. The information also is recorded in their patient records. “The sheet is problem focused, and has a lot of counseling and coordination of care built in,” Dr. Bauer said.
If a patient comes to the session late, there is no lost time or productivity for the MAT team, because the group meets regardless of who attends. Patients can come as much or as little as they like every 1-4 weeks. “It’s very flexible,” Dr. Bauer said.
She does not have data on her patient outcomes in the group setting vs. the individual one, but Dr. Bauer said in an interview that she believes it is as effective and allows more people who need MAT to receive it, because few clinics in her state offer it.
The group structure does place more demand on the hospital’s pharmacy, she said, in that, after the sessions, patients arrive en masse to fill their buprenorphine prescriptions.
Questions about confidentiality do arise, although each session begins with a reminder to keep private what is shared during the meetings. However, Dr. Bauer said, she thinks some patients remain reluctant to speak their minds for fear of what they say not remaining confidential. “This can limit the depth of what’s discussed,” she said.
Dr. Bauer said she did not have any relevant financial disclosures.
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