Q&A with Dr. Tom
How can I capture diagnostic codes on patients that never come in to see me?
That’s a tough one. Much to my chagrin, I was never ever to get 100% of the patients in to see me for a routine visit during a given calendar year, my best was 97%. Nowadays, it’s getting even harder. Patients are getting constantly pestered by phone, email and internet to get all manner of interventions and they are getting tired of it. The lowest hanging fruit is to target patients who have not been seen because it’s physically difficult to come into the office. In other words, do a house call.
In a high volume, high overhead fee-for-service world, home visits are a financial loser. But in a value-based system where the clinician has skin in the game, house calls will generate enormous returns in many different ways. In fact, you can identify high-performing value-based systems by whether and how often their primes do house calls.
Be careful though, you just can’t show up at a patient’s house and submit a visit. The patient must be unable to physically leave their abode due to infirmity or the symptoms of that infirmity such as pain. If you can document that, then you can submit the visit for payment—and all the documented diagnoses that were addressed.
Just as important, house calls are a phenomenal marketing tool. Once the word gets out on social media that you’re willing to do them, your phone will ring off the hook. And the regulatory limitations will protect you from the expectation that they can be offered routinely.
Safety is always a concern. HIPPA precludes taking a family member along on a house call, so I will usually arrange to meet a home health nurse or care coordinator at the residence if I am in anyway concerned about the environment I’m entering.
Visiting my patients in their home provided me with an enormous amount of information that helped me care for them more effectively and reduced their care costs. I bonded with my patients, learned about their care givers and made friends for life. Make your appointments around noon or after five and be prepared for a free meal.
And that’s the most important benefit of making house calls, turning back the clock and once again practicing medicine with joy.