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

Neil Chesanow

Disclosures

July 20, 2016

In This Article

Different Operational Strategies

Many firms offering housecalls on demand are fairly new to the business. Most offer free apps that patients download to their smartphones and can use to request a housecall.

Some apps connect a patient directly with an on-call clinician. Other apps, particularly those from larger firms, allow patients to view clinician headshots and professional information—education, specialty, years in practice, and patient reviews— and choose a specific clinician.

To request a visit, patients enter their personal and health information, including presenting symptoms and their location, into the app. It generally takes only a minute or two to receive a response.

A housecall request does not always go directly to a clinician. Some apps route the request to a command center, where a nurse does triage. This can involve a brief video chat with a patient, conducted through the app, to determine whether a housecall is necessary. In some cases, patients can choose a video or phone session with a clinician instead of a housecall, which is more immediate and costs less.

The clinician's safety is gauged during these patient interactions. If there is any doubt, the company might send two people, at least in theory. Although provider safety has not been a problem to date, according to spokespeople from several firms, it is not taken for granted.

In general, clinicians are dispatched to housecalls in company-owned vehicles. Most travel solo, but with a backpack equipped with wireless diagnostic equipment, medical supplies, often medications, and a tablet loaded with EHR and e-prescribing software.

Some firms dispatch only physicians on housecalls, others send only NPs, and some deploy one or the other, depending on the shift. If NPs are sent on housecalls, a physician at a remote location is generally available—through text, phone, or video chat—for consultation if the need arises.

Clinicians are usually a mix of full- and part-time staffers, and are generally paid competitive hourly rates. The firms pick up the tab for malpractice insurance.

Most firms offering housecalls on demand focus on urgent care, as do firms that offer video chats with clinicians, but some are branching out into primary care by offering services such as physicals, wellness exams, and flu shots.

These firms are not necessarily in competition with local physicians; they provide service after hours or when office-based physicians tend to be booked solid. Hours of operation are typically 8 AM to 8 PM. And some firms offer ongoing primary care to people who don't have a regular primary doctor—quite a few app users don't—or who are dissatisfied with the doctor they have.

A growing number of housecalls firms take insurance. Insured patients pay standard office copays rather than out-of-pocket rates. If a patient is uninsured or has a high deductible, rates generally range from $50 to $200, which is about the cost of an office visit, less than an urgent-care visit, and considerably less than the trip to the emergency room (ER) if one is paying cash.

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