Madelyn Young contributed to this post
If you’re looking to bring more cash into your primary care practice, leading-edge solutions like telemedicine may look appealing to you as a way to earn extra revenue. Although telemedicine looks to play a larger role in the future, the payment details, licensing requirements across state lines, and other important issues remain to be worked out.
What can you do in the meantime? Perhaps your income booster doesn’t lie in the forward-thinking medical services of tomorrow. In fact, maybe you should look to the past for a revenue-enhancing care delivery model.
House calls may be the retro solution to some very current problems – low reimbursements for primary care services and poor access to care for the elderly.
Medicare provides a higher reimbursement for home visits than it does for in-office encounters. If your practice is hurting financially and you typically see a wealth of Medicare patients on a given day, consider setting aside one day per week in which you solely offer house calls.
Sure, many doctors argue that the incrementally increased payment rate for house calls isn’t high enough to motivate them to see patients outside the office.
“Although demand for the service is building, the number of family physicians making house calls is shrinking,” Beth Loney Oller, M.D. points out in a June 2015 post for the American Academy of Family Physicians. She adds that, in a 2010 survey of AAFP members, 19% said they made at least one house call a week. By 2013, the number had fallen to 13%, and only 3% of respondents said they made more than two house calls a week.
How much more money you collect for a house call depends on the services you provide. In 2010, a new-patient visit performed in-office earned a doctor about $37 from Medicare. The same visit rendered at a home nets the doctor around $54 – just $17 more. But while the highest-level Medicare visit typically reimburses a physician around $131, if it’s performed in a patient’s home it’s reimbursed for about $165 – $34 more.
Potential Pluses and Minuses
As such, a well-planned day of house calls can certainly earn a physician more cash than a day of Medicare visits in the office. If that doc can additionally lower overhead expenses by paying fewer staffers to work in the office on “house call day,” the income impact can be even more significant.
Then again, seeing patients at their homes does require that you invest in portable medical equipment and pay the costs of transportation. But becoming comfortable with those expenses may now make you better prepared to earn significant house-call payments later.
A provision of the Affordable Care Act law mandated the creation of the Independence at Home (IAH) project, which CMS launched in 2012. The project goal is to look at “the effectiveness of delivering comprehensive primary care services at home” and determining if those efforts “improve care for Medicare beneficiaries with multiple chronic conditions.”
Not unimportantly, the IAH program offers incentives to participating healthcare providers who prove that they are providing quality care that reduces costs for Medicare. Practitioners who meet the CMS’ quality and patient satisfaction standards will be eligible to receive a portion of the money they help save Medicare through reduced numbers of hospitalizations, ER visits and tests. Results released in 2015 for the first year show of the practices who earned an incentive payment, the amounts ranged from $275,000 to $2.9 million.
The IAH estimates that Medicare spending could be reduced at least $15 billion a year – more than $150 billion over ten years – if the Independence at Home program were fully implemented across the country.
A New Subspecialty?
Believe it or not, the IAH may turn out to be a Medicare program that boosts payment, improves patient care and lowers costs. Even before the IAH leaves the demonstration phase, you may find that home visits are beneficial for your practice and your patients, thanks to those increased rates and increased demand discussed above.
Home care medicine is becoming a specialty, of sorts, within primary care, Steven H. Landers, MD, MPH, told Medical Economics. Especially regarding the care of homebound elderly patients, the future of home care looks bright. Increased Medicare payments, the overall aging of the U.S. population, mobile technology and data showing patients prefer home care could each contribute to the resurgence of the house call, says Dr. Landers, president and chief executive officer of VNA Health Group in New Jersey.
Map out your business plan and run some numbers to find out if house calls are right for you – you may discover that their higher Medicare reimbursements can boost your bottom line.