Too many total appointments? Virtual Centering and in-person

Katie - Thank you for the idea. That is looking like what we will be doing - something similar. I appreciate the input.

This is a helpful discussion, as we too are trying to implement virtual groups.   For the traditional care model during COVID, we usually see women in person in the first trimester, and then do telehealth at 14-18  weeks.  Per the Maternal Fetal Guidelines our practice uses, the 20 week sono counts as an in person visit, and we follow up with telehealth.  We do telehealth at 24 weeks, in person at 28 weeks, telehealth at 30,  in person at 32, telehealth at 34, in person at 36 weeks.  Most of our moms can get BP cuffs, and we can do weekly telehealth up to 39 or 40 weeks.  I especially like the idea of scheduling all the visits ahead of time, both group and individual.  And the suggestion to have seven group sessions with office visits for the other visits is interesting.  Katie, can you share how you adapted the content of the sessions when you went from 10 to 7 sessions?

This is such a helpful discussion between all of you!  I'm wondering, Chelsea, if  doing the clinical assessment during the group visit time, if 2 hours, with the provider using break out rooms to do the same quick assessent they would do in the corner in an in-person group would help with group schedules?  Some sites are getting vitals equipment to the group participants, e.g. BP cuffs, wt scales, fundal height measuring tapes and dopplers, then training patients in clinic with the provider and MA. Patients take their vitals, minimum BP and weight, before the virtual group session, with someone navigating bringing patients in and out of the breakout room for the provider.  The provider tries to keep the clinical assessment in the breakout room the same amount of time they would use as in-person group assessments.  This way questions from patients can be referred to the group for facilitation, rather than the provider answering these questions if clinical assessments are done after the group session with telehealth or in person at the clinic the same day.  Most sites doing these virtual groups work on what clinical assessment pieces need to be done in the breakout room to make it a billable visit.  Then amended schedules bring patients into the clinics with 1:1 visits with their Centering group provider for those visits that require lab work, such as the 20 week sonogram or 28 wkg glucola draw,  etc, as well as provider determined in-person visits, outside of the lab needs visits.  There is a wide variety of amended schedules with virtual and in-person visits and some of the posts on this thread include this variation in what sites are doing.  It does reduce the number of 1:1 clinic visits if you can have providers doing the clinical assessents in the virtual session breakout room.  One site said their minimum to be able to bill was to have the patient take their BP and assess fetal movement, plus asking all the regular clinical questions that go with this assessment. 

Hi Lisa - you will find some helpful info in the "Guidance" file under "Tools for Virtual Centering Groups" in the Resources section of the CHI website portal here:  www.centeringhealthcare.org/store/virtual-group-resources
I'm sure others will chime in but I wanted to highlight that for you as well.  Patients are scheduled for the entire group session time and taken one-by-one into virtual breakout rooms, so the particular time for each patient is flexible during the group session.