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For House Call Services, the Time Is Here

2008;18(1):10

Grandma Louise had become increasingly forgetful. Could she have Alzheimer’s disease? Concerned, her adult daughter contacted Bronx-based House Call Medical Services of NY, PLLC, founded by Edwin Quinones, RPA-C, and Sumir Sahgal, MD. An hour later, when Sahgal visited Louise, she offered him a cup of coffee. “She put on coffee and turned on the gas, but forgot to light the burner,” Sahgal recalls. He quickly removed the knobs from the woman’s gas stove, and House Call made arrangements for an aide to cook for her.

This is only one of House Call’s many success stories. For Quinones, who has been a PA for 14 years in a variety of settings, house call work is his passion and his true calling. “I just love what I do,” he says. “My patients treat me like family, and I really feel like I’m doing some good.”

Whether they serve high-end business travelers in big cities, homebound mothers in the suburbs, or rural elderly patients, house call services are becoming increasingly popular throughout the country. In just three years, Quinones and Sahgal have expanded their practice from 70 to 400 patients. “There’s a little bit of a buzz about house calls,” says Naomi Friedman, RPA-C, founder and chief medical officer of Sickday Medical House Calls, LLC, a thriving practice that addresses acute care needs in Manhattan. “This is a growing trend.”

A Welcome Option
So what’s driving the demand for good, old-fashioned house calls? Many factors come into play, says Friedman, beginning with changes in the US health care system. With 47 million uninsured, emergency departments (EDs) are crowded, unpleasant places to be. The average wait time for an ED visit is about four hours, Friedman says.

Meanwhile, as financial pressures force many primary care practices to fold, patients wait an average of two days to see the family provider. For many, time is money. They would rather pay $250 out of pocket than sit with a sick child for hours in an uncomfortable ED.

A Perfect Fit
As house call services grow and expand, physician assistants and nurse practitioners are a key part of their success. That’s because NPs and PAs are so well suited to this type of care, says Deonne Brown, DNP, APRN-BC, a researcher and faculty member at Seattle University College of Nursing. Advanced practice clinicians are more holistic—more interested in the big picture and in preventive care. They also work well in a highly collaborative environment.

For entrepreneurial PAs and NPs, the house call market is one to be considered, says Brown. A study that she conducted showed growing acceptance and appreciation of advanced practice nurses. Compared with health care consumers of 20 years ago, today’s patient is more willing to visit an NP for primary medical care. Patients in western states are especially familiar with NPs and report high satisfaction levels, Brown says.

Brown links the growing demand for house call services with the recent trend toward concierge medicine. “It’s related to consumer-directed care,” she says. “It’s centering things around the patients’ needs, and this is just an extension of that.”

At Sickday, PAs and MDs actually deal with hotel concierges. Many of their clients are business travelers who develop urgent health needs away from home. One businessman awoke with an earache the morning before his flight home. A Sickday provider was able to reduce the man’s pain and resolve his concerns.

Stay-at-home moms love the service too, Friedman says, because they don’t have to bring all three kids to their clinician’s office when just one of them comes down with strep throat or the flu.

Many patients are young, healthy, and self-employed—film directors, writers, and fashion designers. They may have only catastrophic insurance but are willing to pay for house call service on the infrequent occasions when health issues arise.

Sickday charges a flat $250 fee for each house call. Insurance often covers that, so the patient’s out-of-pocket cost may be about $40.

Expanding Markets
Another successful house call company, Miami-based My Home Doctor, LLC, has entered the corporate market, offering packages to busy executives who can’t afford to lose a day waiting in the urgent care clinic. The company also serves the area’s elderly population, which will continue to grow as more baby boomers turn 65.

With plans to expand into the Los Angeles market in 2008, both My Home Doctor and Sickday expect to add advanced practice clinicians to their staffs. “As our business grows and our patient population grows on the chronic care side, PAs and NPs will have all the skills and qualifications necessary,” says Mark Price, CEO of My Home Doctor. His company has plans to expand into 14 US cities.

Are You Cut Out for House Calls?
House call work may be a lucrative market, but it’s also very satisfying, Quinones says. Every day is a different adventure, and providers feel that they are helping people who might otherwise fall through the cracks in the US health care system.

Some practitioners are attracted to house calls because they believe the start-up costs and overhead will be lower than in other types of medical practice, but Quinones and Sahgal strongly advise investing in an office and a full-time scheduling staff. They also favor electronic record-keeping software and small portable devices, including a pulse oximeter and a portable x-ray machine.

Other components they would recommend? A strong marketing plan, excellent communication skills, a collaborative outlook—and a good set of tires.

But most importantly, Quinones says, house call practitioners need the right kind of personality and worldview to be cut out for this kind of practice. “This is part of the global outlook for us,” he says. “We’re trying to give people better quality of life and keep them out of the emergency room.”      

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