Four tips for adding house calls to your practice

As payment rates for house calls increase, technology improves, and the population ages, interest in home-based primary care is growing.

Under Medicare rules, house call patients are not required to meet the homebound definition required for receiving skilled nursing and therapy services in the home. And as of January 2019, Medicare no longer requires documentation of medical necessity for every home visit, describing why a house call was needed in “lieu of an office visit.” So, there is now greater flexibility in choosing patients for home visits.

The best candidates are patients with complex or high-risk conditions who have difficulty getting to the office:

• Frail older adults with multiple (often five or more) chronic conditions and deficiencies in activities of daily living (ADL).
• Younger homebound patients, usually with one principal neuromuscular condition such as multiple sclerosis, amyotrophic lateral sclerosis, or cervical spine injuries (some on ventilators).
• Patients with high-risk diagnoses like congestive heart failure and chronic obstructive pulmonary disease.
• Patients with high hospital and emergency department (ED) utilization in the past six to 12 months.
• Patients with hierarchical condition category (HCC) scores greater than 2.0.
• Post-acute, transitional care management (TCM) patients who would benefit from a short course of home-based primary care that reduces complications and readmissions.

Here are four tips for getting started with home visits.

1. Set geographical limits.

A geographic radius should be determined for home visits based on driving time (e.g., no more than 20 minutes from the physician's office or home). For more distant patients, telehealth may be the better option for providing care, at least while it is allowed under the public health emergency.

If you also offer house calls to patients in domiciliary settings (e.g., assisted living facilities or group homes), you can realize economies of scale by seeing multiple patients in the same location on the same day. The payments are roughly the same as home visits.

2. Follow scheduling best practices.

Efficient scheduling is critical, and can be achieved through the following steps:

• Start with a half day or one full day of house calls per week. Then increase that time as volume demands.
• Schedule patients in close proximity by assigning days to specific geographic areas and using mapping/routing software.
• Call when en route to the visit so the patient is ready.
• Have staff record special instructions on the schedule (e.g., "enter through side door").
  

3. Complete certain tasks before the visit.

Make sure that clerical tasks are done by staff ahead of time, including obtaining signed forms and medical records (e.g., HIPAA forms, consent for treatment, or medical history forms) when possible.

Also, review charts before the home visit to see if fasting blood work or any unique supplies, such as injections or immunizations, are needed. It's also a good idea to review charts for complex, new, and transitional care management patients ahead of the visit and start pre-charting.

4. Have your black bag ready to go.

Unlike in the office, you cannot walk down the hall to a supply closet if you run out of something during a home visit. Have your "black bag" stocked and ready. Here's a list of recommended supplies for home visits. You'll need to keep track of what supplies are used, and then restock at the end of the day.

Read the full article in FPM: “House Calls: Providing Care Beyond the Office Walls.”