Building a Thriving House Call Practice and
Profession: Annual Meeting Boasts Record Breaking Attendance!
by Jessica Quintilian,
Assistant Executive Director
The Academy’s Annual Scientific Meeting held on April 29, 2009 at the Hyatt
Regency in Chicago, Illinois was a sold-out success. This year’s
meeting "Building a Thriving House Call Practice and Profession” drew
record-breaking numbers, as members gathered to learn how to grow from an
individual practice to a large, flourishing one. New this year, and highly
valued by our members, were the five-minute "What I do – why I’m a home care
provider” segments interspersed between longer presentations. These candid
presentations from our members included some key survival strategies that YOU
can use to grow your practice.
1) Implement an EMR.
A key to practice growth for one highly successful member,
Dr. Alan Kronhaus, was the implementation of a fully integrated, internet-based
practice management system with an excellent EMR and a documentation tool that
was created using the graphic programming capabilities built into the system. Technology is essential if you want to build
a thriving practice.
2) Know your billing.
Another success strategy mentioned by Dr. Kronhaus is being
well-versed in Medicare’s documentation guidelines and coding rules. Educate
yourself on how to bill at the appropriate level of service and how to protect
your records from auditors to the extent possible. Many questions on the
Academy’s list-serv address billing issues, and our wonderful resource Making Home Care Work in a Medical Practice:
A Brief Guide to Reimbursement and Regulations is updated annually.
3) Practice effective
This includes following the principles mentioned in Dr.
Gresham Bayne’s presentation "The Roads Not to Travel in Building a House Call
Practice.” Dr. Bayne mentions that "one of the ten dumbest things he ever did”
was to buy an expensive car. He cautions members to carefully consider issues
that can derail their practices such as physician salaries, limiting their
practice to a black bag, hiring W-2 employees versus contractors, retail
advertising, hiring drivers and making decisions based on idealism. (In other
words, if Medicare does not pay for a service, don’t do it!)
4) Use the right technology.
Why do house call practices need technology? Dr. Edward
Ratner explained in his "Practical Technology for the House Call Practitioner”
presentation that house call medicine requires technology for both clinical
quality and efficient operation. What a house call replaces drives technology.
The WPS Local Carrier Decision for house calls states that "the service must be
of equal quality, as if it were performed in the office.” Technology minimizes
the need for patients to leave home, minimizes turnaround time for orders and
referrals, meets Medicare standards, minimizes HIPAA and compliance risks and
can generate income for the practice. What technology is required to provide
quality care at patient residences? Dr. Ratner divided the answer into two
categories: basic primary care office diagnostic technology and basic medical
office administrative technology. Diagnostic technology includes sphygmomanometer,
thermometer, otoscope/ophthalmoscope, oximeter, ECG and phlebotomy.
Administrative technology includes and electronic patient database, fax,
copier, phone and computer/internet access. Dr. Ratner estimates that a
start-up solo practice needs $3,000-$10,000 in technology investment.
Other keys to growing a practice mentioned by our speakers
included marketing, which can be as important as your investments in
technology. Do not forget to get the word out so that people know your practice
is an option. The Academy receives daily calls from families looking for house
call providers. If you are not listed in our referral directory, ask for a copy
of our ethic statement. (Listing requires annual signing of our Principles of
Ethics). Dr. Eric DeJonge mentioned in his "Top Ten Clinical Pearls”
presentation that much of their success comes from listening to patients and
families, and trusting nurse practitioner, nursing and social work staff.
Many of you have benefited from our popular booklet Making House Calls a Part of Your Practice and
the steps to starting a practice, which help to define the scope and focus of
your practice. The Academy has recognized that a definite need exists to help
our members "get to the next level” in growing their practices. We are developing
a long-awaited new booklet focusing on practice management to serve as a
resource to members who are looking to grow their practices. Watch for details
later this summer on when the booklet will be made available.
President-Elect Thomas Edes, MD, filling in for Joe
Ramsdell, began the lunch time Annual Meeting by thanking our sponsors: Barton
Medical Corporation (lunch sponsor and exhibitor), Abbott Point of Care,
Lockton Affinity, Mobilex USA and TIMS, Inc. Dr. Edes highlighted some of the
Academy’s accomplishments for the year, including the pending reintroduction of
IAH, achievement of ONCHIT National Strategy 1.3.9 and the recommendation of
Dr. Gresham Bayne to the HIT Standards Committee and Jim Pyles to the ONCHIT federal
policy committee, efforts to fight exclusion of house call providers in
e-prescribing and HIT, addition of codes to the denominators of PQRI measures,
efforts to oppose CMS payment reductions in certification/recertification and
care plan oversight, audit updates and new resources available to our members.
Dr. Edes announced the new Academy endorsed medical malpractice insurance program
offered through Lockton Risk Services. For more
information on the program. He then updated members on efforts to come in
these areas, as well as new efforts including a home-based research network,
improvements to our home care exam and new resources for medical
Board member and chair of the awards committee Dr. Thomas
Cornwell presented this year’s prestigious Eric Baron House Call Doctor of the
Year Award to Theresa Soriano, MD of the Mount Sinai School of Medicine
Visiting Doctors Program. Dr. Soriano
joined the respected Mount Sinai Visiting Doctors Program in 2004. Colleagues say, "From the outset, it was
clear she embodied fresh perspectives, academic rigor and an untainted idealism
in the care of vulnerable populations.
She showed an enthusiasm for her work that was infectious.” After two years, she assumed the role of
Program Director. Under her leadership,
there was an expansion of research with publications in peer-reviewed journals,
augmentation of social work,
increase in palliative care training, an increase in resident and medical
student teaching, development of a nurse practitioner hospital-liaison model to
improve care of homebound patients in the hospital and effective and efficient
transition back to home, and an enhancement in philanthropic and foundation
Dr. Soriano is a
strong advocate for house call medicine and an outstanding, caring clinician. A letter of support for her nomination from
the New York State Office for the Aging praised Dr. Soriano for her advocacy
work and for helping to develop medical training curriculum and evaluation
methodology for home visit programs. Despite extensive administrative
responsibilities, she is persistently in the trenches, delivering much of her
care to the homebound in East Harlem and Washington
Heights in some of the most
impoverished and dilapidated locations in New
York City. In
2007, she was given the Mount Sinai Visiting Doctors Program Resident Teaching
At the AGS Presidential Poster Session, Thomas V. Caprio, MD
received the Poster of the Year award for his poster on "Home-Based
Screening of Rural Community Dwelling Older Adults by Emergency Medical
Services and Referral to Transitional Case Management." Congratulations to
Dr. Caprio and his entire project team!
One member’s comment aptly summarized this year’s meeting: "If
you missed this year’s meeting, you missed out on a sentinel event for home