How Healthcare Delivery is Changing
The face of healthcare is changing in America, somewhat in part due to Affordable Care Act, but the delivery system of healthcare has been inching towards yesteryear for some time now. Yes, I did say yesteryear, do you remember the TV drama Marcus Welby M.D. where the kindly, all knowing Marcus Welby M.D. made house calls and saved the day? Well, now it would be more of a reality show, because house calls are becoming an increasingly important component of disease management, treating the elderly and other specialty areas of medical care today.
Differing Delivery Models and Payment Methods
In fact, it was 1993 that the start up Mobile Doctors first began making house calls in the Chicago – Detroit areas, and doing so in 1993 with Medicare paying doctors just $40.00 to $60.00 dollars per house call, you have to wonder how they could get doctors to sign on to make them when the average office visit cost patients about $55.00 dollars in those days. The $40.00 to $60.00 dollar Medicare reimbursement couldn’t possibly cover a doctor visit and travel expenses.
Things did improve in terms of reimbursement for Mobile Doctors making house calls though; in 1998 Medicare increased the reimbursement rate to $60.00 to $140.00 dollars per house call depending on how complex the visit was. The increases in reimbursement enabled Mobile Doctors to grow the company, bringing more doctors on-board. Today, Mobile Doctors has 13 physicians, almost half of which are podiatrists, treating over 1600 patients whom are almost entirely geriatric patients (95%).
This year the Medicare reimbursement rates are $58.00 to $209.00 dollars, again fee reimbursement based on the complexity of the visit and the geographic location, yes reimbursement fees have come a long way since Mobile Doctors inception. So much so that the physicians at Mobile Doctors making house calls has become quite profitable, its two locations saw fees generate between $750,000 and in excess of one million dollars last year.
And as far as a practicing physician’s schedule goes, you can’t beat the hours. Each physician makes about twelve house calls a day and is paid a per visit fee for each one. When the day is done, its over, there are no evening hours or nights on call or on call weekends for these doctors, nights and weekends are handled by staff nurses.
Furthermore, it is clear to see, as time marches on so do the Medicare reimbursement rates. Which are what they are, thanks, in part to the American Academy of Home Care Physicians (AAHCP); an organization that has lobbied heavily to increase the reimbursement rates for house calls. The AAHCP executive director, Constance Row states that there is still much to be done in terms of reimbursement, in that there are areas that have hiccups in reimbursement payment structures, specifically in areas such as travel time reimbursement and rates for visits to assisted living facilities; according to Row.
Some House Call Doctors Don’t Accept Insurance
But, not all doctors making house calls today operate in the same manner as Mobile Doctors, for example another company making house calls called HouseCallsUSA of South Florida is catering to travelers who are in need of a doctor for non-emergency purposes. HouseCallsUSA has a network of over two thousand doctors from all over the United States who have agreed to see patients on a pay per visit basis, typically for a fee of $225.00 cash, credit card or check only. The doctors at HouseCallsUSA will come to you anywhere in the continental United States; they will see you any time, day or night including weekends at your location. It’s a bit pricey for the average healthcare consumer, but there certainly is a market for it.
Then there are also the high tech versions of house calls, one such version is an app called Heal in California whereby you can summon a physician to your home or business for $99.00 per visit. The cost is not covered by insurance, but for many people the out of pocket cost is well worth it if you have to consider the cost of taking time off from work to see a doctor in their office, if you can get an appointment that is.
Just the idea of being able to skip the overcrowded doctor’s office full of sick people (and their germs) is enough for many people to happily fork over the $99.00 fee. The services offered by these traveling physicians is a variety of non-emergency type services such as treatment for; flu shots, flu and cold, strep throat, ear aches, treatment of lacerations, stitches and burns etc. Actually much the same type of treatments as you would receive from an urgent care center or in your primary care physician’s office.
There are various business models being applied in different parts of the country for in home healthcare or also known as house calls, in example; Heal in California will “get a doctor to your sofa in under an hour” for $99.00, Pager out of New York City will send a physician or nurse practitioner via Uber for $200.00, MedZed out of Atlanta will send a nurse to your home to conduct the physical exam and then connect remotely via laptop with the physician who then prescribes the treatment plan. As you can see the modality may vary from one company to the next, but the goal is the same to deliver timely, quality healthcare to your doorstep at reasonable rates.
Healthcare Consumers Welcome the Change
As far as healthcare is concerned the return to “house calls” is being welcomed by healthcare consumers. Primarily because it is providing in-home healthcare to a variety of patients and their needs; from the elderly who are not completely housebound, but a trip to the doctors office is complicated and requires other costly services and special transportation, to the executives or typical ordinary workers who find it much more costly to take time off of work to go to a doctors office, to the stay at home mom or dad with three kids, who doesn’t want to have to take along two other healthy children to a doctors office full of sick kids for the doctors visit with the one who is sick, house calls, and the many variations of it, has definitely found a place in American healthcare today.
Examining the Possible Negatives to This Approach
Objectively, it is important to examine any negatives in this approach to medicine, one of the most alarming already rearing its ugly head is the potential for Medicare fraud, which sadly appears to be a valid concern, particularly in the area of Medicare Advantage plans where it appears home visits are not only under scrutiny, but the subject of federal lawsuits alleging widespread fraud.
Other areas of concern have been raised by urgent care center advocates and primary care physicians, which have stated that they basically offer the same services (typically and very nearby), but maintain in a more professional setting with a continuum of health care, with safer, more sanitary conditions than do house call visits.
The House Call Doctor’s Opinions
In response house call providers state that even though the conditions that they are providing healthcare in may not meet ideal conditions, the house call provides benefits only they can derive such as; the patient being more at ease and forthcoming, the attendant (doctor, physician’s assistant, nurse practitioner, nurse) may be more apt to better understand the patients true condition and needs given they are seeing them in their own environment and able to spend more time with the patient than a doctor would in an office or ER setting.
Conclusion
As with any form of healthcare there will be the need of fine tuning the “details”, and certainly weeding out any hint of fraud, but returning to the “house call” appears to be just “good medicine” in the opinion of many professionals in the healthcare field, as well as meeting the needs of the Affordable Care Act agenda to reduce hospital readmissions and Emergency Room visits.
