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The Do’s and Don’ts of House Calls



We’re gonna be talking about house calls, do’s and don’ts bringing this straight from my private practice, my extensive experience with house calls, and also other practitioners that I’ve worked with as well.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello, and welcome to another episode of To The Point. I am Dr. Nell with American Acupuncture Council. So excited to have you here. We’re gonna be talking about house calls, do’s and don’ts bringing this straight from my private practice, my extensive experience with house calls, and also other practitioners that I’ve worked with as well.

So let’s go to the slides.

So when we think about house calls there’s a few misconceptions that come up and things that we wanna address straight out the gate. And I first wanna tell you a little bit about my experience with house calls in general. I built my practice treating primarily post-surgical patients. So house calls or being on location were really a necessity for the patient demographic that I was working with.

And as my practice continued to build and as I continued to network directly with surgeons and gain referrals directly from. Surgical practices it really grew and grew. And so then when Covid happened a few different things shifted, and I started looking at, all right, how are we gonna continue to build our business?

How do we safely continue to treat patients? Things had shifted quite a bit and started looking at the numbers. Because my lease in Beverly Hills was up for renewal. And a lot of you who have brick and mortars, you’ve looked at medical leases, sometimes they’re a little bit longer trying to make these really big decisions around what to do next when it comes to your practice.

And when we looked at the numbers, we realized that over 80% of our revenue was from house calls. And granted, this was definitely a situation where it was very much based on our business model, treating post-surgical patients, but at the same time, house calls can be incorporated into most practices.

We are gonna go through these misconceptions, but also just know. Having primarily house call patients is not for every practice. Some people are gonna do this about 20% of the time, 10% of the time, and we’ll go through some of those different options. But first, let’s talk about the misconceptions.

There is an idea that house calls are not safe. That they’re not cost effective. You’re gonna be leaving your office and running over to a patient’s house or that they can be cumbersome. You’re lugging equipment, you’re not able to do everything that you would normally do in office, and there is some truth.

To actually all three of these. And so they’re really good and bad ways right and wrong ways. And then with the little bit of ambiguity that’s gonna be around what your business model is what area you’re in. So is it really feasible to be running back and forth? How does that work? So we’re gonna center this around these three different areas and look at some good do’s and don’ts for each one so that.

These misconceptions are not your reality if you wanna do house calls in your practice. So first, let’s look at the safety issue. We have personal safety and then we have the professional or practice safety, thinking about things like malpractice issues, but what we’re thinking first and foremost about our own personal safety.

We’re talking about going to a person’s home, right? So someone that maybe you don’t know very well. Or maybe you’ve seen an office once before who was a referral or maybe even a cold call, and that can be a little intimidating and that can certainly be an unsafe situation. So are there certain safeguards that we can put in place to stay HIPAA compliant in this situation?

But also allow ourselves to be able to safely navigate into someone’s home. And some of that will have some overlap with talking about logistics at the end and how we safeguard some of those safety issues. But first and foremost, we wanna just acknowledge that this is a different environment.

It’s not exactly the same thing as when you’re in the comfort of your office, the comfort of your practice. You don’t get to have everything set up exactly how you want to, you’re not gonna have cabinets at. Someone’s home probably have things at an arm’s reach. So we’re really thinking about what things are we going to bring with us so that we can keep safety paramount.

What we wear to a house call is particularly impactful in this case. So if we were in office and we like to dress. Business casual. Or we like to wear business casual with a lab coat. Might be easier to wear scrubs. I had always worn scrubs for house calls, and then when I was in office I was a little bit more dressed.

And then during C O V I D I was wearing scrubs the entire time for both in-office. And on location. So that’s something to think about, like what you’re physically wearing to someone’s home. Also what are you bringing with you and how far are you traveling safety-wise? So I do house calls where I have to get on a plane and fly to patients.

Now, because I’m between a few different states where I’m licensed. And so when I do that, you’re thinking, okay, safety-wise, like what am I bringing on a flight with me? There are certain things that you might take locally that you’re not gonna be able to safely carry on an airplane. I will tell you I have never had an issue with acupuncture needles, microneedling devices even eim units on a flight for a carry-on.

So just as an aside for those of you who are thinking about doing that but we wanna think about like things like batteries, like being safe when we do that and going to someone’s home I will tell you from my practice, we don’t do just. Direct cold calls. We are primarily referral based, so when a patient calls, they’ve been referred directly from a surgeon.

And this can be a really safe way to do this process because you at least know the referral source. Someone who is Requesting that this person see you, this person is like, Hey, my friend or my doctor told me that I should come to your practice and that you do house calls. So I know providers who don’t even advertise online that they do house calls.

They have their regular practice structure, and they do the house calls on an as needed basis for us, because we were primarily referral based, it was really easy. We always involved the surgeon in that care and in that visit, so that patient knew that someone was going to be reported back to, they were signing paperwork that said, Hey, my information can be shared with my surgeon.

And so we were saying, Hey, like we’re gonna let your doctor know when we’re on the way to your house and let them know how that went. So at least then they know there’s another party involved in that and that gives you a little bit more of that safety. When I was doing this on my own as a sole proprietor and I didn’t have an office staff I was still very referral based, so there was still that communication, but I would always let someone know that, Hey, I’m going to a house call and I would listen.

Someone know Hey, I’m done with that house call, and that doesn’t mean I need to share the patient information. All of that information would be in my E H R, which is HIPAA compliant. But just to be able to let another party know that’s that was happening and that makes you feel a little bit safer.

When we talk about cost I will tell you industry standard from practitioners I’ve worked with and talked two throughout the industry is just doubling the cost of your in-office visit from a cash perspective. I would say that there is no one size fits all approach when it comes to cost.

However, you really have to think about where you are and what it’s going to take for you to get to that patient. For example, me being in Los Angeles, it takes a lot to leave a practice, get in a car. Drive somewhere. It’s very different if you’re in a more accessible city that maybe has public transit or that allows you to pop in and out of the office or, maybe you have a very densely populated area where you’re treating people in super local confined area so you’re not traveling that much.

That’s gonna be different time taken out of your office. So you have to consider when you’re constructing your costs, okay, how is this really gonna work? If I’m normally running three rooms at a time, what am I actually losing by walking out of my practice, the time that is spent away? How many patient visits is that truly?

And as long as you are in compliance with ADA and like people can easily access your office. It’s fine to give people a choice. I would keep my pricing exactly the same for in-office and going to location, and I would charge separately for a travel rate, and that was a way that I was able to safeguard to just.

Be able to say to people, Hey, you’re welcome to come into my practice if you would like me to come to you. This is the travel fee. And so that way you’re keeping your fees the same. And so it’s really a conversation about your time and the money that’s spent with that. So that’s one option and one way to go about it.

But the most important thing when you’re considering cost is what does it cost me to leave? And does that make sense? It might not make sense for your business model when you are looking at. What that is going to cost you leaving your office and going to someone’s home. And then the last thing is logistics.

And the reason that I say this has a big overlap with safety is because look at the picture that we have here, cupping, right? When I do house calls, I don’t do fire cupping. I just don’t I love doing fire cupping in office, but I use suction cups when I go to someone’s home. They are easier to transport.

There’s less of a safety issue there. Logistically it’s a little bit easier to navigate one simple suction cup and maybe an oil or ment rather than having to worry about. Am I going to have a tray accessible? Am I going to be able to deal with fire in this person’s home? Are they going to feel safe?

When it comes to that? We wanna think about things like linens. Really, when you’re thinking about the logistics, you wanna think about that entire experience. What is that gonna look like from you getting in your vehicle or getting in the transportation that it’s going to require? Are you lugging a treatment table?

We’ve. Purchase treatment tables for patients before, when we have a post-surgical patient who’s committing to say 24 visits after a surgery, that is not a big deal for us to then have a treatment table to keep at their home so that our providers are not then lugging that treatment table every single time.

And it’s something that’s a huge value add for patients usually that they really appreciate as. Part of something that is going to make life easier for you but be a value add for them. So it’s set up, it’s easy when you get there. You wanna think about things like sheets. I used to always bring linens to house calls.

And then when C D happened and people were a lot more careful, we started having patients providing their own linen for treatment tables. And it’s about the way you frame that, you frame it, that it’s for their comfort, their safety they know it’s not being reused. They don’t have to trust that you’re washing it properly or disposing of things and reusing, or not reusing.

There’s no guesswork involved there. So that’s another thing that can be done. But really, if you’re thinking about that process from start to finish, how do we make this logistically sound? I like to expect the unexpected anything that has come up in a previous house caller that we could anticipate we do.

So everything from knowing what the gate code is. Do you prefer the provider to stay with you next to the treatment table or would you like them to wait, outside? Do you allow shoes in your home? Cuz you have to think about that from a clean needle technique perspective. Not wanting to walk around completely barefoot.

Things like that. Is there, are there gonna be pets there? If you’re having yourself or a provider go to a home and you’re allergic to dogs or cats, that’s probably something that you wanna be aware of. Some people are very, free with their animals. They let them jump around. You wouldn’t want that to be, become a safety issue, and it’s something to anticipate logistically on the front end that makes that process a lot more simple.

So obviously if it’s just. You can ask a lot of these questions on the front end. It gets even more critical to be clear about these logistics when you have other providers that you’re employing going to someone’s home. So knowing all of those variables upfront can be really impactful and just make for a very simple experience, even knowing if someone, let’s say a post-surgical patient.

I’ve had post-surgical patients that can’t get out of bed, or they’re in a hospital type bed at their home, so there’s no reason to bring a treatment table. Knowing those things on the front end not only help you deliver a better patient experience, but it makes the patient so much more comfortable with what that is going to look like, and it helps manage those expectations.

So as we briefly recap these are the three things you really wanna be thinking about when it comes to house calls. First and foremost, it’s always gonna be safety, your personal safety your professional safety. Protecting yourself against anything that could potentially happen. You wanna think about costs.

Does this logistically make sense as well? Is it cost effective for me to be leaving my business to be doing house calls? And then the logistics of not only that actual house call, but how are you setting that up? How are you framing that? How are you going to fit that in logistically to the way that you practice even considering things like scheduling?

Do you want to. Devote, certain hours of the day to house calls, which is something I used to do. So that you aren’t bouncing back and forth oh, my Monday afternoons and my Thursday afternoons are going to be my house call days. So logistically, how do we make this a sound process? So if you keep those three things in mind, and of course come from a personalized perspective like we do with anything in this medicine looking at your individual practice and how this makes sense for you.

Please do not hesitate to reach out to me if you have more questions about this. I love looking at the safety aspects. Obviously working with American Acupuncture Council safety and that protection is paramount in my mind. But really how could you make this work from a business perspective?

So thank you so much for your time. And don’t forget next week to tune in for another episode of, To The Point.