Podiatry House Calls

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Hello! I'm just wondering if anyone out there is making house calls as a podiatrist. I'm in an area with significant qualifying demographics and considering trying to reach out the several geriatric practices and PCMH as well as retirement communities. Pros, Cons, encouragement?
Thanks for your input,
SouthPod

I know of a guy taking house calls, and he makes decent money off those patients. He did complain of driving into the more urban areas, and a patient or two tried to take his car.

Originally Posted by SouthPod

Hello! I'm just wondering if anyone out there is making house calls as a podiatrist. I'm in an area with significant qualifying demographics and considering trying to reach out the several geriatric practices and PCMH as well as retirement communities. Pros, Cons, encouragement?
Thanks for your input,
SouthPod

To keep a long story short, about 3 years ago my grandmother's lower limbs and feet had diffuse venous stasis ulcers and pressure wounds. I'm guessing ischemic ulcers as well (her hallux auto-amputated itself at about the 1st MPJ level and many wounds were full thickness). For 2 years running a podiatrist has been coming to her home. At first it was about once or twice a week, then once or twice a month, and now the visits are monthly. The podiatrist would debride, apply hydrogels, dress the wounds, etc. Her condition has improved dramatically, it may have been limb/life-saving.

I shadowed this podiatrist for a half day last week. She saw 7 patients in 4.5 hours. Her trunk looked like a hospital wound care clinic on wheels. Also, I've seen my grandmother's bills and I'm guessing this podiatrist's little side business is pretty profitable.

Originally Posted by JonScholl

I shadowed this podiatrist for a half day last week. She saw 7 patients in 4.5 hours. Her trunk looked like a hospital wound care clinic on wheels. Also, I've seen my grandmother's bills and I'm guessing this podiatrist's little side business is pretty profitable.

How far is this pod traveling between patients? Are these patients in close proximity to each other?

Originally Posted by JonScholl

To keep a long story short, about 3 years ago my grandmother's lower limbs and feet had diffuse venous stasis ulcers and pressure wounds. I'm guessing ischemic ulcers as well (her hallux auto-amputated itself at about the 1st MPJ level and many wounds were full thickness). For 2 years running a podiatrist has been coming to her home. At first it was about once or twice a week, then once or twice a month, and now the visits are monthly. The podiatrist would debride, apply hydrogels, dress the wounds, etc. Her condition has improved dramatically, it may have been limb/life-saving.

I shadowed this podiatrist for a half day last week. She saw 7 patients in 4.5 hours. Her trunk looked like a hospital wound care clinic on wheels. Also, I've seen my grandmother's bills and I'm guessing this podiatrist's little side business is pretty profitable.

Although it's admirable and a needed service, don't start counting this doctor's money so fast. Most insurance companies pay LESS for visits in the home or services provided in the home. No, they don't take into account the time or travel expenses. Their view is that there is no overhead when at a patient's home (no rent, electricity, equipment costs, staff costs, etc.) and therefore pay at a lower rate.

Additionally, did you see the bill for the services or actual amount PAID??? There's often a HUGE difference. If our practice received anywhere NEAR what we actually billed (not received), we'd all be retired and I'd be writing this from my yacht in the Riviera.

Our office would be bankrupt if we saw 7 patients in 4.5 hours. As an average, in our practice we would each see about 27 patients in that same time.

One more point. Although I'm not implying that this doctor bills inappropriately or unethically, those practices do exist in our profession and all professions. It is very easy to bill big numbers and even get paid big numbers, but if audited the result is often not so pretty.

I served on an insurance panel and a DPM who performed ONLY housecalls was audited. He received (not billed) $835,000 average over the prior 3 years. That's a huge number for one doctor with no office performing only house calls. Because realistically, when performing housecalls there is a finite number of patients you can see daily. This doctor had no office, no staff, etc., so that $835,000 was basically pure profit less his travel/auto expenses.

The audit revealed that he billed ridiculous amounts for each visit. He often billed multiple procedures on one patient. According to each patient when interviewed, he was basically just performing palliative/routine foot care, yet his average bill per patient exceeded $600 per visit.

The authorities knocked on his door for the investigation and he had no documentation, no charts, etc., etc. You do NOT want to know the sad ending of this story.

But to answer your original question, there are many DPM's who enjoy making housecalls and can make a fair living doing that if they are billing ethically.

Originally Posted by PADPM

Although it's admirable and a needed service, don't start counting this doctor's money so fast. Most insurance companies pay LESS for visits in the home or services provided in the home. No, they don't take into account the time or travel expenses. Their view is that there is no overhead when at a patient's home (no rent, electricity, equipment costs, staff costs, etc.) and therefore pay at a lower rate.

Additionally, did you see the bill for the services or actual amount PAID??? There's often a HUGE difference. If our practice received anywhere NEAR what we actually billed (not received), we'd all be retired and I'd be writing this from my yacht in the Riviera.

Our office would be bankrupt if we saw 7 patients in 4.5 hours. As an average, in our practice we would each see about 27 patients in that same time.

One more point. Although I'm not implying that this doctor bills inappropriately or unethically, those practices do exist in our profession and all professions. It is very easy to bill big numbers and even get paid big numbers, but if audited the result is often not so pretty.

I served on an insurance panel and a DPM who performed ONLY housecalls was audited. He received (not billed) $835,000 average over the prior 3 years. That's a huge number for one doctor with no office performing only house calls. Because realistically, when performing housecalls there is a finite number of patients you can see daily. This doctor had no office, no staff, etc., so that $835,000 was basically pure profit less his travel/auto expenses.

The audit revealed that he billed ridiculous amounts for each visit. He often billed multiple procedures on one patient. According to each patient when interviewed, he was basically just performing palliative/routine foot care, yet his average bill per patient exceeded $600 per visit.

The authorities knocked on his door for the investigation and he had no documentation, no charts, etc., etc. You do NOT want to know the sad ending of this story.

But to answer your original question, there are many DPM's who enjoy making housecalls and can make a fair living doing that if they are billing ethically.

What is the difference in reimbursement for a qualifying medicare DFC patient versus a house call in your locality? I understand that people have misused this service and been audited, but they same thing happens with wound care, ultrasound guided injections, etc. I'd rather not discuss someone else's integrity.

Originally Posted by Ankle Breaker

How far is this pod traveling between patients? Are these patients in close proximity to each other?

I'm looking for less than five miles, most would be in a retirement community type setting.

Originally Posted by SouthPod

What is the difference in reimbursement for a qualifying medicare DFC patient versus a house call in your locality? I understand that people have misused this service and been audited, but they same thing happens with wound care, ultrasound guided injections, etc. I'd rather not discuss someone else's integrity.

If you read my post carefully, I clearly stated that I was not implying that the doctor you shadowed was billing unethically or inappropriately. I just thought it was important for everyone out there to realize that you should not be impressed with/or in awe of any doctor simply due to the amount of billing. You should be more impressed by the way the doctor treats his/her patients, his/her morals and ethics and of course his/her skills.

I also never stated that the abuse is isolated to doctors who perform house calls or doctors who perform palliative care. I clearly stated that dishonesty occurs in podiatry and ALL professions.

I have no idea regarding the reimbursement for house calls for "at risk" foot care, vs the same service provided in the office. I do not make house calls, nor do I do the billing for our office. We have a billing staff of 6 dedicated to those issues. I do know the reimbursements for procedures I perform, but I do not make house calls so can't answer that question.

Please note that the actual service may be paid at a lower rate (let's guess at 10% lower), but many docs who make house calls also bill for a home visit. However, once again this is something that is often questionable. In some localities, a doctor is really not supposed to provide home services or bill for a home visit if the patient is not home bound. If a patient goes to his/her primary care physician, but has consistent home visits by the DPM, it questions the actual need for a home visit to this patient.

Early in my career, I did make a few house calls for patients who were home bound. I remember arriving at the home of a patient who "had no way to come" to my office, etc. When I arrived at her home, no one answered the door. As I was leaving she pulled up in her car and said she was running late because she just came from the hairdresser. I guess she simply had different priorities.

I believe that Medicare has watched this issue over the years for several reasons. One reason is that it was not uncommon for some podiatrists to have a strictly house call practice with no overhead as discussed before. The doctor would abuse the system by going to a senior living type of apartment building and advertise his/her services. The doctor would then simply go from apartment to apartment to apartment and clean up.

Obviously, not all these patients required house calls, but it was simple and quick and there was a captive audience. The patients didn't cancel for rain, sleet or snow.

My only real concern with doctors who make many back to back house calls is the sanitary concerns regarding instrumentation. They obviously can't sterilize instruments on the road, and I don't think MOST carry a set of instruments for each patient. So that's a concern I do have, though I'm confident there are many docs doing everything "kosher".

It may be worth the effort if you have a hybrid vehicle. Good luck with this endeavor.

Originally Posted by PADPM

Additionally, did you see the bill for the services or actual amount PAID??? There's often a HUGE difference.

Yes, I am aware of this. I understand how to read a bill.