Medicare House-Call Only Practice—Update

It’s official, starting in 2019, you don’t need to be seriously ill to qualify for a house call under Medicare and Medicare Advantage—the government just officially changed the rules.



With that in mind, let me update you on the progress I’ve made in starting my own, boutique Medicare Advantage house call practice.



The best initial contract I can get with a payer is a 50-50 split with a $35 per member per month (PMPM) initial monthly payment—not bad.



My malpractice for a 300-patient practice in Missouri is $6k/year in Missouri—occurrence with a tail.



After checking all the open source EHRs out there, using Word with my own macros is by far the most cost efficient.  I won’t even use an electronic prescribing tool.  In a low volume practice, it’s just as easy to call meds in.



I can submit my charges on my insurer’s own portal while keeping a spreadsheet record for a quarterly submission just to make sure everything gets sent in.



I can use the slick patient information package from Cisne Health for a few dollars pmpm. The data comes from the insurer’s own systems, so there’s no new hardware or servers on my end.



I can’t guarantee that you could get that price, but the focused data and the simplicity of the presentation is worth 50 times as much, or more



My business office is my home, I priced a 2017 Hyundai Sonata from CarMax for $16,000 and I’ve engaged a part-time long-term business support staffer through Upworks at $25 per hour. My phone, $200 per month.



It’ll take me three months to get credentialed should I decide to proceed.



Clinician performance will vary of course. Income in the first year is projected:



The most reasonable worst-case for a low performing clinician—-$50 PMPM for 200 patients—That’s $120K a year gross.



A low-average physician—$100 PMPM for 200 patients. That’s $240K gross.



An average doc—$150 PMPM for 300 patients. That’s $540k gross.



For a master like myself—depending on how hard my wife lets me work, a 50-50 split would get me $300 PMPM for 500 patients—That’s a lot of money.



I’ll decide in a few months whether or not to pull the trigger.



You can decide now.



Contact me if you want me to help.