Practice Management Alert

If your practice is looking for a way to keep your patients happy while reducing your expenses, house calls could be the answer for you.

With decreasing patient numbers and an increasing elderly population, physician practices are looking at every alternative to "traditional" medicine to help improve patient care and to make money. Offering house calls is one option some practices are looking at. Check out this expert advice to find out if house calls are right for your practice.

The first step in deciding whether house calls are right for your practice is to look at the benefits of this increasingly popular option.

Home visits let the physician "see the entire circumstances of the patient and therefore provide better and more patient-centered care," says Constance Row, executive director of the American Academy of Home Care Physicians (AAHCP) in Edgewood, Md. "There are a variety of benefits, but they can be summarized into better patient care," agrees Dike H. Ajiri, chief executive office of Mobile Doctors in Chicago. "Making house calls increases access to care for our homebound elderly, allows physicians to actually look in a patient's kitchen to see how well he's eating, observe how safe the home environment is, better assess for risk of falls, better assess for neglect -- all while providing equal or better services (X-ray, ultrasounds, EKG) than found in a typical doctor's office."

Bonus: House calls also offer increased professional satisfaction for the physician. Marc Tanenbaum, MD, a pediatrician in Atlanta, is considering house calls mainly for quality of care and professional satisfaction reasons.

"In coding for office visits, time is the least important feature, unless counseling is greater than 50 percent of the visit. When time is valued, it is undervalued," Tanenbaum says. "Cognitive time is not valued by the health care system. The incentive is to move the assembly line along and achieve through-put. This may result in dollars, but it is not professionally satisfying, nor is it satisfying to the public/patient."

"House calls have become more common, since reimbursement went up," Row says. According to the Practice Management Frequently Asked Questions on the AAHCPWeb site, "Medicare now pays significantly more for house calls than ever before."

"Reimbursement generally dictates what physicians can and cannot do," Ajiri says. His practice is 100 percent geared toward making house calls, which allows the physicians' services to be more cost-efficient.

What it means to you: Decide how many house calls your physician can realistically perform in a set time frame, such as one month. Then, run all the numbers -- payment from the in-home visit, travel cost, etc. -- and see if your practice will make or lose money by sending the physician, physician assistant, or nurse practitioner on the road.

For example: Consider whether you can reduce overhead costs by having less office space since your physicians will be seeing fewer patients in the office. Keep in mind that you will not be able to seek reimbursement from your payers for travel costs, such as mileage. You also need to determine what percentage of your services will be house calls, and if that will be costeffective.

"Reimbursement from Medicare is adequate, but being able to provide 3,500 house calls a month greatly helps with economies of scale in being able to provide cost effective care," Ajiri adds.

Bottom line: If the pros outweigh the cons, your practice may want to consider adding house call services, just as Tanenbaum plans to do. "I want to practice medicine, spend the time with the patient and on the patient's behalf in researching diagnosis and treatment issues, in coordinating care, etc. -- and not be a CPA or run a 55-60 percent overhead," Tanenbaum explains.