Housecalls: A return to an old delivery model competes with office visits

Some housecall businesses send a doctor to a patient’s home in a Prius. With others, the physician arrives at a patient’s home via an Uber-dispatched car or even public transportation. Still, other companies offering this service send a nurse practitioner or a licensed vocational nurse to a patient’s home. While many companies have jumped into the housecall space, it seems that the business model is a work-in-progress, reports Medscape.

It's also unclear how this old-fashioned care delivery model will compete with the traditional office visit. Tom Rodgers, who works as senior vice president at McKesson Ventures, touts the great experience his family had with San Francisco-based Heal Mobile, which sends out a doctor to patients’ homes in cars driven by medical assistants. But Rodgers, whose young son was treated for a painful earache, is unsure how companies providing this service can be profitable and scale appropriately.

"I paid $100 for my last Heal visit," Rodgers told Medscape. "They sent a doctor and a medical tech to my home, and they were there for 40 minutes. I don't know that the math works that well when you try to scale that."

Despite this, there are housecall services firms sprouting up around the country--generally in urban areas such as New York, San Francisco and Minneapolis--that are trying a variety of approaches to providing near-on-demand care for patients in the comfort of their homes.

Many of the startups focus on having clinicians practice “at the top of their license” and within a team-based approach to care. For example, New York-based Pager, founded by Oscar Salazar, Uber’s former chief technology officer, sends out nurse practitioners (NPs) and physician assistants (PAs) to patients in Manhattan and Brooklyn between 8 a.m. and 8 p.m. 365 days a year. NPs and PAs dispatched to a patient’s home have access to a physician for consult by video, phone or text, reports Medscape.

While they offer convenience, it's unclear whether housecalls will have a permanent place on the healthcare scene or compete with traditional primary care practices. While Sam Kim, M.D., a Los Angeles-based pediatrician who works for Heal relishes the opportunity to spend more time with his patients in their homes, Michael Oppenheim, M.D., also a Los Angeles-based physician employed by Heal, isn’t quite as enthusiastic. Whether it’s because of a simple cold or multiple chronic conditions in the case of an elderly patient, housecalls aren’t always the appropriate mechanisms for delivering care, he tells the publication.

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