Ideal Micropractice/Mobile Practice/House Calls

[deleted87716]

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Another SDNer (JMPeffer) and I recently exchanged some PMs about his ideas for an IMP based solely on house calls. I'm posting the contents of that exchange here with his permission, as the information may be of interest to other folks on the forum.

I'm really interested in the Micropractice model. How feasible would it be for a doctor to carry what he needs to run a clinic in an Ambulance sized truck. Say I wanted to drive from Nursing home to Nursing home and basically, outfit an ambulance w/ all the supplies I would need for a micro practice.

This is basically what I was getting at:
http://www.aafp.org/fpm/20060200/67cash.html

5K overhead, 150/200 hr. Sounds like a pretty simple gig.

Location, location, location.

The estimated median household income in 2005 in Longboat Key, FL was $103,600, compared to $42,433 for the rest of Florida ( http://www.city-data.com/city/Longboat-Key-Florida.html ).

I'm sure that's an important part of the author's business plan.

So, Dr. Brand was set up in a fairly wealthy area, eh? I'm still hopeful this could work in an area with a more standard median income.

So, I found this Monitor (http://www.aafp.org/fpm/20020900/monitor.html), which cites a WSJ article I'm too tired to find that says Medicare Reimbursement rates for housecalls are significantly higher than for office visits. I figured if you combine that with an extremely low-overhead mobile practice, a great EMR system used via laptop, and a successful practice is very possible. Additionally-I figure one could work with patients w/o insurance using a Cash-based practice too, without having to worry about some of the hassles traditionaly involved in mixing a thirdy party payer system with a direct payment system.

Oh, I'm sure it's possible. However, you'd want to sit down and run the numbers just like you would with any other new business venture.

This article may be useful, if you haven't seen it already:

House Calls: Taking the Practice to the Patient
http://www.aafp.org/fpm/20000600/49hous.html

I did a quick check at the CMS fee schedule lookup site ( http://www.cms.hhs.gov/PFSlookup/ ), and the reimbursement for established level 3 and level 4 home visits are about 22% and 20% higher, respectively, than their office-based equivalents.

For Virginia:

99348 $74.01 (home visit, level 3)
99213 $57.72 (office visit, level 3)
---> Home visit is 22% higher

99349 $108.14 (home visit, level 4)
99214 $86.77 (office visit, level 4)
---> Home visit is 20% higher

Of course, if you factor in third-party billing and collection expenses, your overhead will be higher than it would in a cash-only practice.

 

[AwesomO]

Thanks Kent, I'm also a big fan of Micropractices.

 

[nlax30]

Good info and interesting articles. I'm sure most of ya'll have seen this guy but just wanted to post this link as he's doing the same thing.
http://www.jayparkinsonmd.com/index.html

In that first article it would be interesting to see what Dr. Brand has her patients do if they need additional testing. As in either refer them to a specific office/clinic or have prearranged rates at various local clinics, etc..

 

[racerx]

Dr. Gordon Moore is a faculty member at the University of Rochester Family Medicine residency program, and one of the pioneers. The residency has even incorporated this into their P4 initiative.

http://www.idealhealthnetwork.com/

His website also had some other links that may be of interest:

https://idealhealth.wikispaces.com/

http://www.idealmedicalhome.org/

http://impmo.org/Camp2008.htm

 

[deleted87716]

I've mentioned my friend, Dr. John Brady, before. He has an IMP he calls "The Village Doctor": http://www.thevillagedr.com/

If you click on the "Practice Development" link on his home page, he includes a lot of very specific information about the startup costs and overhead for his practice.

 

[racerx]

I've mentioned my friend, Dr. John Brady, before. He has an IMP he calls "The Village Doctor": http://www.thevillagedr.com/

If you click on the "Practice Development" link on his home page, he includes a lot of very specific information about the startup costs and overhead for his practice.

It's not surprising that he is one of the mentors for the camp2008 in one of the links I posted. Drs. Brady and Moore are the two that come to mind whenever I daydream about running my own micropractice someday.