Do doctors do home visits?

The short answer is yes, doctors still do home visits, although not nearly as much as they used to. Being a home visit doctor in Colorado Springs, I can say that my experience is unique. While there are other doctors and providers who do home visits in Colorado Springs, they are few and far between, and I’m the only orthopedic surgeon doing it. In fact, I may be the only orthopedic surgeon who does home visits in the entire country. Home visits used to be the norm back in the earlier part of the 1900’s, and it is estimated that home visits by a doctor accounted for about 40% of visits in the 1930’s and 1940’s. 

Why don’t any doctors do home visits anymore?

By 1980, home visits by a doctor accounted for only 1% of visits. The reason for the decline can be traced back to the introduction of medicare in 1965, it changed the entire game. Suddenly there was a giant pot of government money that was now available to doctors. In the beginning, medicare would reimburse doctors reasonable and customary rates, which of course were defined by the doctors. This led to doctors getting reimbursed really high rates making them richer than they had ever been. Over time medicare realized that to curb runaway spending they had to change the system. This led to the introduction of the RVU or value based system. This meant that medicare would only pay a certain amount for certain procedures, so the doctor could charge whatever they wanted, but they would only get reimbursed so much. One of the problems with the RVU system is that it doesn’t really value home visits by a doctor. In other words, medicare doesn’t believe home visits by a doctor to be worth that much, so they don’t pay them that much for it, and create a lot of restrictions in order for the doctor to get paid. Private insurance companies often follow medicare’s lead, and the end result is that no insurer really wants to pay for a home visit by a doctor. The result is that without getting paid appropriately for a home visit, doctors stopped doing them.

Why do you do home visits?

I believe, as an orthopedic surgeon in Colorado Springs, that home visits by a doctor are a mark of good care. I don’t take any insurance or medicare, so this frees me from their restrictions. I like to spend 45 minutes to an hour with my patients to really explain things to them. When I’m done there are rarely any questions about what the diagnosis or treatment plan are. That is the value of being able to spend more time with my patients, I can educate them. Patient education is also something that insurers and medicare don’t really want to pay for and therefore don’t really value. Not taking insurance, and not working in a clinic also frees me from the oversight of hospital administrators and insurance company executives. While they may be smart people, most of them are not doctors, and if they are doctors they probably haven’t practiced medicine in a long time. They have lost sight of why they became a doctor. I don’t want those people inappropriately inserting themselves into the doctor patient relationship between me and my patients. I think this is the change in the US healthcare system that we need. And I’m doing my part to change it.

I hope I was able to answer your questions about home visit doctors. If you still have any questions or want to schedule an in person or virtual consult, please feel free to contact me.

-Written by Dr. Daniel Paull

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