Doctors Making Housecalls

However, there is one practice in the area that does do home visits: Doctors Making House Calls. I recently spoke with CEO and Co-Founder Alan Kronhaus, a physician himself.

Roughly 100 clinicians, half of whom are physicians, and half are "advanced practitioners," meaning physician assistants (PAs) and nurse practitioners (NPs).

Who are your primary clients? What percentage are living in retirement communities versus at home?

Our clients are 97% complex elderly patients. Of those, roughly 85% live in retirement communities (mainly assisted and independent living), and 15% live in private residences.

What is your range of coverage (geographically)?

The entire state of North Carolina, with the exception of the most rural/remote areas.

Why do people move their primary care to you?

They often "try us" for the convenience, but stay with us for the quality of the medical care and the exceptional customer service, which includes many distinguishing features, especially compared with the typical practice, community or hospital-based, and even concierge-type practices.

What is the process for doing so?

All a patient or a patient’s representative needs to do is register with our practice. It’s easy to do, and there are several options. They can call our headquarters office (919-932-5700 or toll free 844-932-5700) and select option #2 for a "new patient team," in which case someone will walk them through the registration process (basic demographics + insurance info; authorization to treat; etc) or they can go to our website, click on the link to our patient registration page, then complete and submit the registration & authorization forms; or they can download our registration app onto their smartphone, either from Google Play or the Apple Store, or by going to www.dmhcregistration.com

How much does a visit cost? (Is there a visit fee or a monthly subscription fee?)

The cost of our professional services varies by time spent and/or the nature of the services provided. Since we are “in-network” with Medicare and Medicaid, our fee schedule for Medicare beneficiaries is the Medicare Fee Schedule for network providers. We bill Medicare directly, so the cost of our professional services is exactly the same as the patient would pay in a doctor’s office, assuming the doctor is "in network" with Medicare. In other words, if the patient has no co-insurance, they would the Medicare co-pay of 20%. If they have a Medicare Advantage Plan, they would pay whatever the Plan’s co-pay is for a primary care physician visit, usually something like $10 - $25. If the patient has co-insurance (Medigap insurance), that insurance will pay some or all of the annual deductible, and the 20% co-pay. For the dually eligible (insured by both Medicare and Medicaid), their insurance covers essentially 100% of our professional fees. In addition to our "professional fees" (what the physician charges for whatever the physician does), we also have a "trip fee" of $95.  It pays for the opportunity cost of physician travel time.  It applies to every visit, but only visits to patients living in a private residence.  We waive the trip fee for patients living in retirement communities which we visit regularly.  There are over 300 of those, which we visit 1 – 3 times a week, depending on our census in the community.  So, for those patients, the cost for our service is exactly the same, or less, than what they would pay in the typical physician office.

What happens if the patient is seeing DMHC at home, but then moves to a community where DMHCs also works? Do they see the same person?

They may or may not see the same clinician. If the community is close to their home, the chances are good they would see the same clinician. One other point is that they would no longer incur a trip fee, as mentioned above.

What happens if a patient needs to see someone urgently--before their next appointment? Can you send someone out quickly or do they need to go to an office? Is there an extra charge?

For urgent care between scheduled appointments, we send someone out quickly – either the same day or next day. In the case of urgent care visits, our trip fee always applies, even in a retirement community, if we see the patient on a non-scheduled day in that community. Patients in a private residence pay the trip charge as usual, nothing extra.

What are the most common reasons for patient visits?

We provide comprehensive primary care services, including laboratory testing and medical imaging, all in the patient’s home or retirement community (except for CT scans and MRs, which require huge pieces of equipment and a special environment.) We also provide podiatry services, which is toenail clipping and paring of corns and callouses. More recently, we started provided dental services, optometry and audiometry. As you probably know, "primary care" includes a very wide range of services, including everything from vaccines (flu, pneumonia, etc.), to caring for the most common problems of older folks, including dementia; congestive heart failure; coronary artery disease; the consequences of strokes and transient ischemia attacks (TIAs); edema; many skin problems like cellulitis and other skin infections, sunburns, and other rashes; upper respiratory infections, bronchitis, pneumonia, chronic pulmonary diseases (COPD); GI problems like constipation and diarrhea; etc, etc.

How do you work with specialists? Do you refer out for things you don't handle? Do you have relationships or does the patient need to do research to find the specialist?

We do refer out things we don’t handle. We have refer relationships appropriate to the area and insurance situation, but we are happy to work with whatever specialist(s) with whom the patient has an established relationship.

Can patients or their families access medical records online like they can if they are part of the Duke health system?

Yes. Through our patient portal, patients can access certain information. If they want more information than what’s available through the portal, they can easily request that information from our office.

Are there any other practices that offer this locally or in the state?

There are other practices which visit patients in retirement communities, but nobody I would recommend; in fact, I would recommend patients stay away from those practices! DMHC is not only the best such practice, but the largest by far. (BTW – DMHC does not provide care in freestanding SNFs (nursing homes, also called skilled nursing facilities.) Our mission includes keeping patients OUT of SNFs, if at all possible. I believe DMHC is the only practice in the state which makes home visits to private residences.

Any additional questions that I haven't thought to ask?

Only two. If a patient is seen by a PA or NP, they should know that DMHC supervises its "advance practitioners" very closely. This is not the case with many practices. If a patient is seen by a PA or NP employed by DMHC, it's like getting two heads on their case – the PA or NP + the supervising physician, which is almost invariably our President and Chief Medical Officer.

The second question is "who owns the practice?" DMHC is owned and managed by the same physicians who started the practice 15 years ago. This distinguishes us from so many primary care practices which, these days, are owned by a hospital or large "hospital system" (think UNC, Duke, Vidant, Carolinas Hospital System, the VA Hospitals, etc.) Unfortunately, that ownership arrangement means that administrators manage the practice and dictate certain aspects of how physicians practice; e.g. how many patients they see in a day, what medications they can or cannot prescribe, how patients are scheduled, etc. It's a bad situation for both doctors and patients, in my opinion, as these administrators often care more about the bottom line than they do about the quality of care.