House Calls Make a Comeback, Make a Living
▸ Types of patients you will see on house calls. Will you see only current patients who are homebound, or will you accept new homebound patients into your practice?
▸ The need for a medical assistant. A house-calls practice typically involves low overhead, but the expense of hiring a medical assistant to coordinate and attend home visits can be a worthwhile expense, particularly in a practice that covers a fairly large geographical area, Dr. Cornwell noted.
In addition to taking vital signs and assisting with electrocardiograms, phlebotomy, and minor procedures, a medical assistant can perform various administrative tasks, such as planning the day, calling patients, filing insurance forms, and/or driving the physician from call to call while the physician makes notes, dictates, or arranges care with home health personnel, he explained.
In his own practice, which covers a large territory and provides a number of ancillary services, medical assistants have been of great value. The cost of a medical assistant is covered by seeing one additional patient each day, which is possible because of the time that the assistant saves, he said.
Offering House Calls Can Be Profitable
With careful attention to costs and billing, providing house calls can be profitable.
Controlling overhead is particularly important, but can be one of the simpler aspects of a house-calls practice. Start-up costs are typically low. Unlike those in an office-based practice, expenses like rent, staffing, and furnishings for the office and examination room can be drastically reduced or eliminated, Dr. Cornwell explained.
As for income, he offered this scenario as an example of how a house-calls practice can generate revenue: On a typical day, and with proper scheduling, it is possible to make eight house calls. Dr. Cornwell makes 10. Based on a year's worth of data in his area, he said the typical reimbursement per patient for a 30-minute visit is $133.
With a 5-day workweek for 49 weeks of the year, this rate would generate $260,680 per year, or just under $235,000 if the practice is made up of primarily Medicare patients.
If overhead can be kept at 40%, annual take-home pay would be about $140,000. If one additional patient is seen each day, annual take home pay in a Medicare-predominant practice would be about $158,000.
Proper billing for procedures performed, extra time spent with the patient (such as for discussing end-of-life care), and ancillary services can generate additional revenue. If the practice is affiliated with a not-for-profit health system, as is the case for Dr. Cornwell, donations are also easily generated, and community grant money can often be obtained.
In his 7 years in a house-calls practice, the program has generated more than $1.5 million in donations, Dr. Cornwell said.
He described one $300,000 donation, which was a patient assistance endowment. The interest from the donation is used to provide medical equipment and supplies for patients in financial need.
