When I started my private practice in 2018, I had no interest in leaving the office. The most efficient way to generate revenue for podiatry was staying in the office. All the staff, equipment, protocols, expenses and even insurance reimbursements were tied into the office. 

I had kept getting calls requesting home visits because patients were bed bound or just didn’t want to leave their home. Many podiatrists in my area don’t offer palliative foot care at all, so I had the opportunity to fill this need. Plus, I had opted out of insurance and became a Direct Care practice, which meant I had the freedom to offer services without insurance regulations, including home visits. 

There was no longer a need to file for a new location of service with insurance or wait on an approval for reimbursement. I would just inform the patient of my fees, show up and get paid immediately. The first time I did a home visit and got paid what I wanted without friction, it felt unusually liberating. I felt incredibly valued, something that had been missing under the insurance regime.

In one visit, I saw a patient who was on hospice care but you wouldn’t know it from meeting this gentleman. He was vibrant, jolly, and easy to chat with. He needed foot care for his sensitive feet and I was able to provide this service. He lived just minutes from my office so it was just a stop on the way home. A few weeks later his wife reached out to me asking about changes in his feet. I was able to do a video consultation immediately, coordinate care with his hospice team and prescribed antibiotics for the new infection he had developed. 

And that was it. A straightforward evaluation and a quick resolution to a new problem, all in the comfort of their home. The family was grateful and I was deeply satisfied at how easy it was to deliver medical care to someone who would otherwise have difficulties leaving their home to see the doctor. 

When I was contracted with insurance companies, doing home visits was never on the radar. I was way too busy in the office to consider it and I was bombarded with all the ever changing rules, insulted by the low reimbursement rates, or risking no payment at all that it didn’t make sense to offer it. Plus, I didn’t really know what it would be like to visit a person’s home as a doctor, so the unknown made me a little fearful. But now I have a protocol to mitigate those fears and I want to be able to share that with other Direct Care doctors who might be interested in offering home visits. This is really old school medicine, and just like vintage goods, should come back into vogue to rekindle the patient-physician relationship. 

How to safely get started with home visit services

1. Offer an initial consultation by video so you can learn about what their needs are. You can learn quite a bit through video that you might miss on a phone call. Since everyone has a smartphone these days, the barrier to access is much lower. This initial assessment also gives you insight to their home setting and to the tools you might need to bring to the visit.
2. Map out their address to see if it is a feasible drive that doesn’t disrupt your work flow too much. If it is out of range, then it’s ok to decline home visits. There will be more opportunities to help.
3. As a safety feature, your iPhone has a Share My Location button that you can turn on and let a trusted person know you’re on the road and when to expect you back. That way you’re accounted for. 
4. Consider digital intake forms and have a credit card on file before the visit so that you have less paperwork to deal with and focus on the patient.
5. Before you leave, clean up after yourself, like used gloves and any trash so it’s not left behind. After all, you’re still a guest in someone’s home. 
6. If you love it and want to expand home visit, give patients and their family a meaningful visit leaving cards and asking for referrals.

Of course, include your malpractice carrier in the conversation about doing home visits to ensure your liability coverage. With  advances in technology, and the physicians’ deep desire to disconnect from corporate medicine and reconnect with patients, home visits are an option to expand our services to those who need it most.