Nowadays, it seems as though everything, from grocery shopping to banking, can be done online, and it appears that the practice of medicine is the next field poised for redevelopment by way of digital technology. Several new web and mobile device applications have recently been developed, launching location-based platforms for physician house call services. These services are predicated on convenience, and connect physicians and patients instantaneously and in real time, without the patient ever having to leave his or her home. So far these services are not covered by commercial insurance, and are thus currently limited to those patients who are willing and able to self-pay.
There are multiple companies that have begun providing services, generally along similar models. Pager, one iPhone application currently providing service in Manhattan and Brooklyn, allows patients to view participating on-call physicians in the area, and allows patients to contact and communicate with those physicians to arrange, if necessary, a house call. Another company, Medicast, provides similar services in South Florida, San Diego, Orange County, and Los Angeles. While some house call companies focus on the frail and elderly, or other homebound patients, these services are focused on patients that are generally healthy, but due to time constraints or other issues, seek the ease of a visit at home or at work. Some employers, such as Microsoft, Starwood, and Costco, even offer house calls to their Seattle-based employees as part of their health benefits, through a company called Carena, as the house calls are far less expensive than the ER visits that the employees might otherwise make. House calls, while previously viewed as a somewhat antiquated tradition, proffer a convenience that so many have come to expect in every facet of 21st century life.
Through the internet, iPhone, and Android applications, a patient may initiate contact with a physician who, via telephone, will assess the necessity for a house visit. If no visit is necessary, the patient is charged only the lesser rate for a phone call, with many of these house call services dovetailing with the use of telemedicine (in states that permit this). If the physician finds an in person visit to be appropriate, the physician will then schedule a time (for some services, this might be between 8 a.m. and 10 p.m., weekends included, and for others this might be 24/7) to see the patient at his or her home, hotel, or office for any number of conditions, ranging from a routine physical to a sick visit. The fees for each physician and service are set in advance, and displayed on the application when the patient chooses which physician to contact. Upon delivery of the services, the patient is automatically charged according to the physician’s self-designated rate via a third party payment processor, using the credit card information required for registration with the application.
Most physicians participating in these applications are doing so as a secondary source of income, in addition to continuing to work in more traditional medical practice formats. Although these companies and their contracted physicians do not process any insurance claims on behalf of patients, patients may submit their own claim to their insurance providers for the visit in order to seek full or partial reimbursement. This is the case even if an individual physician is in a particular patient’s insurance network. This upfront, self-pay model presents a supplement to the income of any physician free from insurance complications, provided they are in or around an area serviced by these applications. While the physician must carry his or her own malpractice insurance, the cost of an administrative staff and the limits imposed on service providers by insurance network contracts may be avoided by participating in this self-pay model where patients are charged at the outset of the visit. Even though the application takes a portion of the payment, the reduction in overhead means that the physician is still able to retain a larger portion than in a traditional medical practice setting.
These services also offer benefits for overrun ERs, as they may decrease non-emergency ER utilization. However, the model does present questions with regard to future development and insurance participation. An application company providing universal access to any participating physician is unlikely to be in a position to contract with an insurance provider and thereby cover its participating physicians or submit claims on behalf of its patient users. Differing state law may also affect the viability of the model in different locations, restricting or even prohibiting such companies from providing physician access in some states.
While the self-pay model is advantageous to participating physicians, the price of convenience requires a patient willing and able to afford the services, and therefore this business model necessarily limits its own growth. Still, in unique markets such as New York City and other prosperous or major metropolitan areas, the opportunity to participate in such an organization may be a profitable supplement for many physicians. If insurance companies decide to participate in such programs, house calls could even go from being a niche market and a relic of the past to being a standard offering in modern medicine.
