How Will House Calls Impact Your Practice?
All you need to know about this returning trend
Medical Office Today
December 15, 2010
by Carrie Rossenfeld
Have you noticed that house calls are making a comeback? It’s true. According to a JAMA report, between 1998 and 2004, the annual number of house calls increased 43 percent, and experts expect this growth to continue.
“I see the need and cost of fixed offices becoming less and less a motivator for independent physicians,” says Thomas W. Loker, COO of Ramsell Holding Corp. in Oakland, Calif. “House calls are once again becoming a viable business process for physicians.”
The proposed Independence at Home Act in the Health Care Reform bill could dramatically expand the house-call movement, according to Thomas Cornwell, M.D., medical director of HomeCare Physicians, a Central DuPage Physician Group practice in Wheaton, Ill. Health care reform is expected to penalize high hospital readmission rates, and house calls have been shown to dramatically reduce readmissions.
What’s more, house calls fit in with the current emphasis on preventive care in medicine, which could mean higher reimbursements and better insurance coverage for house calls.
“A focused push by the AMA or other physician groups to recognize this form of practice can help combine the drive to lower cost of care and potentially incorporate mobile treatments with higher reimbursements, as long as the home practice can also tap into the gains of prevention,” Loker says.
So does it make sense right now for you to add house calls to your list of specialties? And if it does, how will it change your office needs and your practice in general?
Think about your patient mix
The segment of the population most benefited by house calls is the elderly, who are often housebound when in need of a physician. Therefore, if you see a lot of seniors it could be a smart move to offer this service. Even if seniors make up just a small percentage of your patient base, the fact that you make house calls could keep them returning to you and recommending your practice to others.
Pediatricians may also wish to offer house calls, since mothers of sick young children don’t relish taking them to the doctor, where they may have to wait uncomfortably. (Similarly, the mothers of children who are there for a well-care visit also appreciate not having to share a waiting room with children who may be contagious.)
On the other hand, patients who work 9 to 5 and prefer to schedule appointments during their lunch break or after work won’t gain much by your offering house calls. Therefore, you’ll need to assess your patients’ needs and preferences to determine how much they would benefit from house calls.
Consider the changing cost structure
If house calls become a significant part of your practice, you may not need as much office space as a traditional practice. Therefore, you could save on rent if you’re willing to downsize.
“Rent is less because the exam room is the patient’s home,” explains Cornwell.
You may even be able to decrease your office hours if you’re out seeing patients, so you could save on staff and utilities costs. (Keep in mind, though, that you’ll be spending more time on travel and money on gas, in addition to the extra wear and tear on your vehicle.)
Since house calls reduce the need for exam room space, you may be able to add physicians to your practice, thereby increasing revenue without also increasing overhead. Sharing office space with another practice also becomes a possibility.
It’s important to note that Medicare payments for house calls have significantly increased since 1997, according to Cornwell, so the financial viability of offering this service could make it worth your while.
Will you need to relocate?
If you’re going to keep your office space in addition to making house calls, you’ll want to live and work close to the patients you’re visiting. It’s likely that most of your existing patients already live near your office, but if you’re adding house calls to expand your geographic reach, relocating may be a smart decision.
However, keep in mind that shifting your office location along with adding house calls may be too many changes for your practice to handle at one time. Moving first and adding house calls six months down the road might make more sense.
How technology can help
While most house call medicine remains quality “low-tech” primary care, mobile technology is making house calls even easier to incorporate into a medical practice.
“Blood tests, pulse oximetry, EKGs, Holter monitoring, pulmonary function testing, X-rays, even echocardiograms and ultrasounds can and are being done in the home,” Cornwell says.
Loker adds: “Thanks to technological changes in the areas of miniaturization of equipment, communications and information systems, the limits of physicians practicing in a mobile environment are no longer definitive.”
Mobile technological advances are also making medical reimbursements and insurance coverage easier for all involved, Loker points out. “As physicians move to this flexible delivery model, coordination of care and benefits systems will become integral in finding all avenues of reimbursement for services provided, increasing access to all patients – wealthy and under-served – to coverage options and virtual collaboration with all other sources of care.”
The streamlining that such technology allows may reduce duplication of services, fraud and abuse, improve outcomes and lower care costs across the spectrum.
“For the many physicians stifled by group practice, I think the technological innovations today are starting to help them develop a new pattern for the practice of medicine that satisfies their personal cultural and mission goals,” Loker concludes.
In the end, offering house calls can be extremely professionally rewarding as you’ll develop a bond with patients that may not exist in an office setting. And since house calls do much to personalize your practice, patients will perceive you as warm, friendly and accommodating before you even ring their doorbell.