Direct primary care without an actual physical office


(Robin Dickinson) #10

And that is why DPC is so awesome. :smile:

Thanks for sharing your information! It sounds like a great method of getting started.

And I totally agree with this…some people opt out too soon and regret it.


(cjs56) #11

Best advice that I have had in 10 years.

Thank you Dr. Haden.

I will also review the web site.


(cjs56) #12

I am learning everyday. I could do it.

Dr. Hayden’s advise excellent…

  1. go mobile until you find suitable office space,
  2. keep Medicare until do not have to moonlight.

Although, a group practice may bill under the group’s Medicare number and it may be possible that a DPC physician would not need to keep active medicare number. But, probably still need to keep it active.


(cjs56) #13

Thanks Matt.

Regarding the neighborhood house call DPC, roughly speaking, I wonder:

  1. what the specific needed equipment would be (I assume ECG machine, blood draw equipment, urine cups, strep screen, ear lavage). Anything else that you used for start up equipment?
  2. what is a rough cost of each item for the rough total of $500.00
  3. your web site is good…very thorough and clear.
  4. Thank you.
  5. Stephen Croughan, M.D.

(cjs56) #14

Hi Dr. Dickinson.
I thought hat Liberty Share was a discounted laboratory.
But, the following are both so-called ministry cooperative programs that offer potential hospitalization coverage for patients:

  1. Liberty Health Share www.libertyhealthshare.org
  2. Samaritan Ministries www.samaritanministries.org

(Robin Dickinson) #15

@cjs56 I’m going to move this discussion about cost sharing to another thread over here


(Robin Dickinson) #16

What you need depends on whom you see and what your other resources are. I personally do not have an EKG machine. I need about 2 EKGs a year in my fairly young population (families with young children mostly). And I have a cardiology practice the next parking lot over who will do an EKG for a good price. I just have patients pay for the EKG but even if I paid for it, I’d save money over buying a machine myself!

Everything you need for blood draws is provided free by the lab generally including urine cups.

Strep tests and so forth you can buy online inexpensively. Docsavings.com usually has good prices on strep tests and cryo and urine dips. For ear lavage, I got an elephant ear wash on Amazon. A lot of equipment is available inexpensively on Amazon. I’ll also do a google search for “cheap [item I need]”. Home healthcare websites are good for things like chux. A lot of small portable equipment for peds is available from websites for midwives. Ultimately, I got most of my equipment used from the garage of a doctor who closed his private practice…the practice he joined didn’t want much of his equipment (probably because he got it from another doctor so most of it is older than me but still works just fine!)

So be creative, think outside the box, and only get what you actually need!


(cjs56) #17

Great. I was asking about the equipment for a “mobile medical practice”…home visits to elderly, etc.).

But, I think most of the equipment Dr. Dickinson was speaking of would relate to both an “office” DPC practice as well as a mobile practice.

I was just wondering if there is anything unique in terms of equipment usage that physician would need with respect to a “mobile practice”…in other words going to patients’ houses?

The other thing that crossed my mind is the suppose a physician was gung-ho on doing home visits but no one in the community wanted a physician to come to their home (all patients wanted to keep their privacy)?

I am sure this has happened and I am also sure that some patients really need a physician to come to their home.

I hove Community Hint. I think the physicians are very smart, saavy and very open-minded.

I also think that this is a very unique and powerful way to communicate.

I am going to tell you some things… on the general Community web site… about FQHC work, San Diego and California in general as well as what I think a patient would want in a home visit (I had an ill parent with Parkinson’s disease that I took care of for 10 years …with minimal help…while doing Family Medicine).

I am 6’3’’ and was down to 163 lbs. at that time.

I am back to my surfing and basketball weight of 180 lbs. now.

The other thing is that Dr. Samuels in Idaho recommended to me to use …“You Tube videos” for DPC info./knowledge.

I started yesterday and spent three hours.

I will do 2 more hours today.

“You Tube videos” are great to mostly encourage you to do something different.

Have some coffee ready…so you don’t doze off.

I finished Dr. Farrago’s book last night…I had to put it on hold to study for Re-Cert this past April.

The last twenty pages are the best…where other DPC doctors talk about their difficulties.


(Chad Weston) #18

Planning on same premise in NC. Two docs established patient panels of 3K each transitioning out of employed position to DPC. Most communication is via secure texting with anticipated <15% of contact with patients in person and likely at home. This thinking makes is tough to justify the overhead upfront. But, after off the runway that may be an expense to reconsider. Ultra low overhead at startup and use future overhead to build value to the existing practice population.


(cjs56) #19

Thanks Dr. Weston.
I was going to ask the DPC doctor in Apex, N.C. what the professional liability costs are for family medicine in North Carolina for a DPC practice…as well as…the costs for a mobile practice like yours???
How much per year? Like California, probably depends on the specific County.
I have a call put into a liability company here in California to see the rates out here.
Some DPC physicians here have told me that they pay $2,000.00 per year out here for liability.
Pretty good.
I put the call into the insurance company out here to see if they come up with the same rate.
i am going to find out the same information for North Carolina, South Carolina and Long Island, N.Y.
The latter (L.I.) is a disaster …as it always is…due to high rates and too few companies. (I think either Physicians Reciprocal or MMLIC …one of the two…went out of business).
CA Insurance company told me that DPC rates may be the same as a "concierge practice."
I will let you know how much it is out here.
As a matter of fact, I may take a day or two out of my schedule to go around with a “mobile company” here in San Diego to try and learn more of the ropes…as an observer. See what it really is like going into the home.
I have done little of this…but a few years ago.
That is, if they let me.
I would think that for “mobile practice”, a physician may have to go to an area where there are many retired patients.
I am not sure how many patient you would need for a mobile practice?
If you were lucky enough to ever get an "age mix of patients…like the “old school family doc”, then I guess you would need only 100 seniors or less since your other patients would be younger.


(cjs56) #20

As I mentioned, my mother had Parkinson’s Disease for 10 years. I was working 32 hours a week.
I had no outside help except for outside agency help which cost $12.00-$15.00 per hour.
Some churches can provide help as well.
Elderly neighbors are ones that a home bound patient needs to befriend quickly.
I was lucky because my mother could not transfer too well at the end.
So, less worry about "wandering."
I believe that a home visit physician can be the most help by simply asking the patient "is there anything specific that I can do to help you in the next hour and is there anyone you would like me to call that may be able to assist you later
on today or that may be worried about you."
If a D.P.C. homebound patient is going to pay a monthly fee, then a family physician’s most valuable asset is ADVICE from previous geriatric patient experiences.
What to avoid and what to focus on.
What caused the downfall of a previous geriatric patient? What caused another geriatric patient to become a little stronger? How can you be this patient’s advocate? The community at large may not be the patient’s best advocate.


(Matthew Haden) #21

@cjs56http://community.hint.com/u/cjs56

Stephen,

You can start very basic or splurge on equipment and supplies. I don’t have itemized prices, but I can send you a link to my Amazon list if you want. I purchased from Amazon, Andameds and McKesson.

Essentials are a functional bag to stay organized, laptop or tablet (excluded from $500 total since most have this already), your equipment for vital signs, rapid strep, urine dip and cups, otoscope, stethoscope, portable weight scale, Rx pads, measuring tape, suture kits, gloves, local anesthetic, alcohol swabs, betadyne swabs, syringes, needles, bandages, suture, scalpels, sharps container, ACE wraps, tetracaine eye drops, fluorosceine strips, a can of freeze spray for warts etc,.

Emergency meds-- Aspirin, epinephrine, Benadryl.

Snelling chart, hearing screening device if you do school physicals.

I keep non-temperature-sensitive items in my primary bag, and anything sensitive in the secondary/procedural bag, which is never is left in my car.

You can add EKG but that’s not first line; it has rarely been needed or helpful since we serve mostly young families. If you plan on doing a lot of geriatrics, you’ll want one, but Medicare covers home health services for truly home-bound, so you can have them do the EKG for you.

I do have a neb machine and albuterol and ipratropium but have yet to use them. My glucometer and strips went unused for several years so I didn’t restock after expiration.

I use a fair amount of ceftriaxone, never used Toradol, sometimes Zofran ODT. Rapid flu test is expensive and not used much…but it came in handy for use on myself and wife. Wound glue is appreciated by families, but expensive. I only recently ordered that. Basic splints for fingers etc are dirt cheap.

We don’t draw blood, but you could, it just complicates your logistics. We have mobile 3rd parties do it or the patients go to a local lab service center when it is convenient for them.

I pack for a lot of contingencies but most visits only use a few things that can fit in an old school doctor’s bag. Hope that helps.

Matt

Live well,

Dr. Haden

Matthew Haden, MD, MPH, MBA

Physician/Owner

www.ModernMobileMedicine.comhttp://www.ModernMobileMedicine.com

P 888.765.1444 x2

F 866.895.6753

Review us on Facebookhttps://www.facebook.com/housecalldoctors and Googlehttps://www.google.com/#q=Modern+Mobile+Medicine&spf=1496526658629


(cjs56) #22

thanks Matt.


(sujata kumar) #23

I have a question about mobile care. what kind of business license do you need to provide mobile care or does the city/county license cover this aspect of care as well?


(Matthew Haden) #24

Sujata,
There’s not typically a separate kind of business license for being mobile per say, it should be the same as any other in your local jurisdiction for your legal entity. You still have to declare a location for your business license, so you may have to list your home if you do not have an office. Most cities will not allow you to use a UPS store box for a business license, but they will allow a shared office location like Regus or WeWork. You should research your area though and talk to a local lawyer. The SCORE network might be helpful as well for advice specific to your city.
Matt


(sujata kumar) #25

Dr. Haden,
Thank you. I haven’t been active on Hint community for some time ,hence the delayed response.
I did open my pediatric clinic in Wesley Chapel( in Tampa Bay Area) FL in May 2018. I am struggling with patient enrollment. So I am considering if adding the mobile aspect would be beneficial.

My concern is also about the practical issues as I am solo at this time.
Kids + Winter = increased illnesses - should I be restricting this based on
Geographical boundaries / illness severity/ special needs.
Should this be offered as part of membership program vs extra service with discount to members.

In your practice do you encounter more children Vs adults utilizing your services?
I would appreciate if you can share some of the experiences and practical aspects about mobile clinic as well as about ways to enroll more members.

would like to also hear from any pediatricians and other family physicians who deal with children and if they are doing mobile care.

Sujata Kumar MD
Novel Pediatric center LLC
P 813-371-0388


(cjs56) #26

I thought seriously about it…and still do. There is a market for it. Places like California and Long Island…maybe less so because they are so entrenched with the typical ways they do things…which is not house calls.

PERFECT EXAMPLE: Rich area like “The Hamptons” a perfect place for house calls…correct? I mean the wealth and the opportunity to “serve the rich” as a doctor in their “McMansion homes.” And, not really anybody doing it.

ANSWER: No. Because you must think of the “traffic.” The place …although ideal for house calls…is a stream of traffic for much of the year because “others” are also serving the rich like pool cleaners, landscapers and the like.

A physician would be constantly delayed in traffic for much of the day (more so in the summer).

Still, these are things that one does not think of unless actual time is spent in the area.

TRAFFIC.

Get a book or two from Amazon regarding home visits or house calls. There is a physician in Wisconsin named Jackie Bristow (I think) who is doing house calls.

Lots of Medicare restrictions…must be “home bound” and a so-called 99214 in CA and NY pays about 120.00 dollars.

Physicians that do it bunch up their visits in nursing homes and the like because they can see more patients at the same time in the same place.

I am not a big fan of nursing homes or “board and care” facilities because not too much of the benefit goes to the patient.

More benefit to the family who does not have to care for “Mom or Dad.”

And, benefit to the facility.

Hope that helps.


(sujata kumar) #27

Thanks. Traffic is a big concern in this area.
I am peds so not a lot of kids in nursing homes and usually we see more medicaid than medicare patients.
Any recommendations about author for house call books?


(cjs56) #28

an African American nurse practitioner in Louisiana.

Can’t remember her name offhand.

But, I will try to look it up.

Check Amazon web site…and you may find her there…under…

house call medicine or home care medicine.


(Julio Bracero) #29

This thread is almost 2 years old. @Robin_Dickinson can you PM me the name/practice of the pediatrician? I’d like to start something similar in the Dallas-Forth Worth area.