Uber. Lyft. AirBNB. HomeAway. Grubhub. Postmates. Wag!
All of these ground-breaking apps disrupted their respective industries providing services straight to consumers with a new twist, with better customer service, and at a lower cost.
Some healthcare start-ups believe the future of health care lies in bringing back good old-fashioned doctor house calls, essentially bringing about the “Uberization” of the healthcare industry. But can on-demand health care that increases access and lowers costs truly work in our 21st century healthcare space? Let’s break down each side of the argument in our first blog post of 2018.
Doctor in the House
Up until around 30 years ago, the majority of a doctor’s practice was made by performing in-person house calls and visits to their patients. Doctors used to know their patients and communities on a personal level, with entire extended families often being served by the same “family doctor” for decades. When cities began expanding rapidly and the amount of equipment doctors needed grew, the family doctor house call quickly became a thing of the past. Patient convenience and comfort was quickly replaced by efficient hospitals, doctor’s offices and modern insurance plans.
Now in the age of technology at our fingertips, multiple start-up companies are challenging the notion of house calls being outdated and inefficient with “on-demand” health care that brings the doctor to your doorstep. With wait times for emergency rooms sometimes stretching several hours and wait lists accruing for primary care doctor appointments, some patients can’t afford to wait that long to see a doctor or healthcare worker. In fact, a 2017 survey found the wait time for a new patient-physician appointment in 15 major metropolitan areas of the U.S. has risen to an average of 24 days, a 30% increase since 2014.
These “on-demand” companies are betting on consumers valuing convenience and comfort as the highest factors in making some of their healthcare decisions. Even with the explosion of 24/7 urgent care centers, transportation to these clinics can be a challenge for the elderly and people with disabilities.
Some of these emerging “on-demand” healthcare companies are making huge splashes in the industry already, including:
How does an on-demand doctor house call work? The process is actually surprisingly simple:
- A patient schedules a house call through the app or website for a time that is convenient for them. They also provide their address, insurance information, and description of symptoms upfront.
- A doctor, nurse or other healthcare worker shows up to their place of residence, work, or hotel for the house call. Depending on the symptoms and diagnosis, the doctor will perform physical assessments as needed, take vital signs or tests, prescribe medications or lab work for further follow-up.
- Patients pay a set or range of fees for their services, typically somewhere between $50-$200. While some companies are purely “out of pocket”, some companies will accept insurers who cover these on-demand services. In this case, the patient would only pay for their applicable co-pay amount. These fees are usually around the same amount as an urgent care visit and less than an emergency department visit.
- Some apps send a digital summary of services provided within 24 hours. Patients can use these documents for any requirements for school, summer camps, etc., right after their appointment.
On-demand, in-person visits are a great alternative solution for patients who are looking to supplement their primary care, or need care that doesn’t require an ER visit but also can’t wait for a PCP appointment, including but not limited to:
- Annual physical exams
- Blood tests
- Colds, ear infections, headaches, etc.
- Specialist recommendations
- Flu shots
- Prescribe medicine
- Family health assessments
Advocates for on-demand health care recognize the house-call cannot and will not replace all types of care, such as surgery or ERs, but they do argue it can be a supporting additional piece to the American healthcare system that is currently struggling to control prices while providing convenient, quality care.
Some of the main reasons proponents cite for the advancement of on-demand health care include:
- Comfort and convenience for the patient. On-demand healthcare is all about convenience for the patient. No longer does the patient have to take off work or travel miles or wait hours in traffic to see a healthcare provider. They can schedule a visit, then quickly be on with their day.
- Supplemental work for general practitioners. On-demand health care allows physicians looking to work supplemental hours the flexibility to do so. Doctors on these platforms can work full-time or part-time depending on their own schedules and practices.
- More quality time with physicians. Doctors can spend much more time with the patient in house calls when they’re not pressed for time in an office setting. On-demand doctors can spend anywhere from 15 minutes to one hour with their patients to ensure the most accurate diagnosis and best care.
- Complete price transparency. One of the biggest issues with the healthcare industry is price transparency. In a majority of cases, patients know beforehand exactly how much their on-demand fee will be before scheduling. This contrasts to emergency room and some urgent care visits where zero price transparency exists. Patients sometimes never know how much care is going to cost until they receive the bill afterwards. As insurance deductibles continue to rise, more people are concerned than ever about the cost of every treatment.
- Little to no insurance required. Some on-demand healthcare companies require no insurance for use of their services. The flat fee is very attractive to patients who are uninsured, under-insured or are in-between insurance plans.
- Reducing ER admissions rates. A USC study of a house call program for seniors found hospitalization rates dropped for patients who were enrolled in the program for 6 months: of 1,000 patients, 96 were hospitalized after being enrolled, down from 159 before the program. These on-demand companies believe their work will help reduce the costs of health care by decreasing unnecessary ER visits, especially when patients fall sick outside of regular PCP working hours.
- Cutting down on the burden of heavy, expensive overhead and administrative costs. A recent study found doctors spend two-thirds of their time filling out administrative paperwork. Proponents argue in-person visits cut down on a majority of the expensive financial and regulatory burdens physicians face when they have an in-office practice with employees.
Opponents to on-demand healthcare believe there’s a strong reason society moved away from house calls: inefficiency. Almost all of the arguments against on-demand health care revolve around the central theme that this type of medicine model is not efficient enough for the 21st century.
These inefficiencies include:
- Limiting to patients in urban areas. One of the biggest drawbacks is the need for on-demand health care to be located in urban markets where there are enough patients to generate a profitable return. At this time, on-demand health care is pretty restricted to urban areas until someone finds the perfect balance or partnership for rural areas.
- Traveling across the city is not the most-efficient way for physicians to spend their time. At a maximum, on-demand doctors can see 10 patients a day performing house calls. This is compared to around 30-40 patient’s primary care doctors are seeing in the office every day. Although house visits can provide a higher quality of interaction with patients, opponents fear primary care doctors need to be using their time most efficiently especially considering the current PCP shortage.
- Not designed for intensive, long-term care for chronic patients unless they see the same physician every time. Unless you can see the same doctor every time for a house call (which you can request with some of the companies), the patient won’t develop that personal relationship needed with their doctor for long-term care. Opponents argue in-office visits or telemedicine visits with the same physician are the only way to foster this relationship.
- House calls are severely limiting in their scope. Although on-demand healthcare companies bring portable equipment units to every in-person visit, the house call is still limiting in what tests and assessments physicians can actually perform.
- On-demand healthcare appears to commoditize the industry. Some opponents fear services like this will have a negative effect on the perception of the health care industry, transforming it from a quality and caring service of medicine to any other commodity or product in the marketplace.
Combining House Calls & Video Consultations- The Best of Both Worlds?
While arguments for on-demand health care can go both ways, some advocates are proposing a mixture of telemedicine video consultations and on-demand house calls to effectively and efficiently meet patient needs.
For example, on the app Pager, patients can chat with a nurse via text message and describe their symptoms. The nurse will then decide whether patients need an in-person visit from a physician or video chat consultation with a provider. This method allows patients and physicians to use their time efficiently while still taking advantage of 21st century technology in the digital healthcare age.
What are your thoughts on on-demand health care? Do you think in-person visits or house calls can make a come-back? Do you think there’s a way for rural hospitals and clinics to incorporate on-demand care into their services? Let us know in the comments below!
Further Reading & Sources:
- The Return of Doctor House Calls: Convenient, but at What Cost? (LA Times)
- Doctor on Demand: How App Culture is Reviving the House Call (Washington Post)
- COLUMN: Is the House Call Really Dead? Not Quite, Says This Doctor Who Makes House Calls (LA Times)
- Return of House Calls: Renee Dua, Heal and the Uberization of Medicine (Mercatus Center- George Mason University)
- COLUMN: Why You Should be Skeptical About an ‘Uber for Healthcare’ (LA Times)
- ·Doctor House Calls in the Uber Age of Patient Convenience (Healthcare Success Blog)
- Why Lionel Richie and Other Famous Investors are Betting on this Uber for Health Care (CNBC)
- COLUMN: This Whole “Uber for Doctor House Calls” Idea is Basically Doomed (Quartz)
- Why There is No Uber for Healthcare (Rock Health)