Housecalls Are Back and Booming. Are They a Threat to PCPs?

Neil Chesanow

Disclosures

July 20, 2016

In This Article

An Old Idea With a Technological Twist

Last year, Tom Rodgers, senior vice president at McKesson Ventures in San Francisco, was returning home with his family from a weekend vacation. His young son had a painful earache and they were stuck in traffic on the Golden Gate Bridge.

So Rodgers used his smartphone to download the app of a company named Heal. He then entered his son's symptoms and other details into the app and requested a housecall.

Fifteen minutes after the family arrived home, a pediatrician and a medical assistant knocked on their door. They had arrived in their company's Heal Mobile, a Toyota Prius, with pretty much all of the diagnostic equipment and medical supplies an office-based pediatrician would stock. They also carried an iPad loaded with the company's electronic health record (EHR) and e-prescribing software.

"They spent an hour at the house," Rodgers recalls. "They had great bedside manner. It was a great experience."

Rodgers has health insurance, but Heal didn't accept it. It wouldn't have mattered if it did; as with many patients, his is a high-deductible plan and the deduction hadn't been met. Still, the fee was reasonable—$100, about the cost of an office visit—if, that is, he could have gotten an appointment when one was needed.

Although virtual video visits with physicians are surging in popularity, many doctors remain skeptical about their benefits. To practice good medicine, these skeptics insist, nothing replaces a hands-on visit.

Now, an industry that offers the convenience of seeing a clinician in the flesh, often within an hour of making a request, without the patient having to leave the house, hotel room, or office, is flowering.

Startups offering housecalls on demand are springing up nationwide. Heal has been in business less than 2 years, yet it already serves five regions in California. Pager is located in New York City. RetraceHealth is based in Minneapolis. Mend and PediaQ serve the Dallas–Fort Worth area. And there are many others.

But not everyone is convinced that Uber-like housecalls have an enduring place in today's healthcare system. The concept has its critics, including doctors who have actually done it. And even though venture capitalists, who are investors, may like what they see, some are not sure that the economics of this business model can be sustained over time.

What is the business model? Which conditions are treated? What is the appeal for clinicians who do this? Can it be profitable to dispatch doctors—or nurse practitioners (NPs)—on time-consuming trips to visit patients, rather than the other way around? They can typically see about one patient per hour, whereas an office-based doctor can see four or more in the same period of time. Is it safe for clinicians to go into strange neighborhoods and strangers' homes? Is this yet another threat to office-based primary care physicians? Let's take a look.

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