Can House Calls Lower Your Doctor's Bills?


Tina Trumeter was out at dinner with her husband and three sons when one said he wasn't feeling well. Worried he may have strep throat, Trumeter called her family doctor to see if he could meet them at their home.

While it might sound like a scene from Leave it to Beaver, it’s actually modern day medicine. The Trumeters are members of WhiteGlove House Call Health in Central Texas, a membership-based routine health care provider.

The Cost of House Calls

The monthly fee ranges from $35 to $100, depending on membership length and whether it’s for an individual or family. The cost per visit is $35, and they'll bring your prescription meds too--generic drugs are free, and you'll pay your insurance plan's co-pay for name-brands. They'll even throw in chicken soup at no extra charge. "The way we make our money is not on visits, but on memberships,” says WhiteGlove president Bob Fabbio. The company keeps costs low by not having a physical office and maintaining a small staff. “We wake up everyday and say, 'How many new members can we sign up today?'"

The service is open from 8 a.m. to 8 p.m. and only for routine health care. For "get-well" care, a doctor is sent to a patient’s home or office within two hours of being called. For "stay-well care" such as a routine physical or vaccine, the appointment is scheduled within 24 hours.

Routine Care

"Less than 1% of the time, we get a call from somebody where we have to refer them to a specialist or the emergency room,” Fabbio says. “We prescribe meds in the field, we suture, we immobilize, we do EKGs." Patients know that the service is only for routine care and that they must go elsewhere for specialists or emergencies.

Insurance factors in as well. Lab work and prescriptions are run through traditional health insurance. Humana-insured patients are privy to free membership. For some members, like Trumeter, this allows them to restructure their health insurance plans to cover mostly emergency medical care instead of paying deductibles on primary care.

How it Compares

According to the Medical Expenditure Panel Survey by the federal government's Agency for Healthcare Research and Quality, the average cost of an in-office primary care doctor's visit was about $100 in 2004. The study found that about 19.4% of this expense was paid out of pocket, but acknowledges the high variation within the survey due to the wide range of insurance providers and the percentage of people covered by insurance.

As Fabbio was quick to point out, statistics like these do not include the price it takes to get there, potential time off of work, potential child care cost while you're at the office and various other costs. Dr. Jordan Shlain, who founded a similar business in San Francisco 10 years ago, says he recently asked a convention, "'What’s more important to you: One dollar or one minute?' Overwhelmingly, the answer was one minute."

His practice charges about $200 for house calls and unlike WhiteGlove, they are open 24 hours a day. While WhiteGlove is only for routine care, Current Health, originally called On Call, also has doctors with specialties such as emergency care and pediatrics. They also have a central office where patients can go for x-rays and various tests.

He says his company emphasizes spending more time with patients to increase quality of care. Many insurance companies, he says, will pay for part of their visit fee.

Around the country, there is an increased need, and desire, for doctors who make house calls, says Constance Row, executive director of American Academy of Home Care Physicians. "The issue [is in] the reimbursement and other barriers are such as that it’s not growing in the way it would be ideal," she says of why the trend hasn't been growing as fast as the demand.

While the membership-based home health care model of WhiteGlove and Current Health is a relatively new trend and not available everywhere, the academy keeps a nationwide database of doctors who make house calls that is free to the public.

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