Charging patients for 24x7 phone access

[Guest guest]

I have become an inadvertent lurker but appreciate the group very much. I want

your input and advice.

For those who don't know me, I started my FP solo imp in 2009 with much

inspiration and assistance from this list. I do 50% office FP work (low

overhead/micro) and diversify my income with 50% of my time doing home visits

for a medium sized hospice. I love the balance.

I have been charging my FP patients $10/ month for 24x7 access and phone advice

in lieu of office visits when it is the right thing to do. Patients can opt out

and pay per phone visit but most gladly pay $100 in Jan or feb for the whole

year with little hassle for me and my one assistant (this lump salary really

helps with taxes)and it is a steal really for my patients and it has been good

enough for me, I like that patients are really happy with it and insurance

companies are happy with it too.

Recently I have been struggling with some sick patients who have become over

utilizers but as a hospice and palliative care doc, I pride myself in helping

people get good care with fewer burdens then the typical office imposes on sick

patients. Still I struggle with the fact that our choices are always stark -

between either giving our services away or creating two tiered medicine. (I

know some will say " or ridding ourselves of third parties " - thank you but that

is a different debate)

I have a new idea and want to share it with the group and get ideas about the

potential pitfalls ( I'm inviting your cynicism and doom-saying).

Today I thought of offering a service of palliative care 24x7 phone access to

patients who need a palliative care doctor. These are high needs patients who

are not hospice appropriate yet, but also are tired of making office visits or

can't go to the ER or don't want to be admitted - they may have been kicked off

hospice for " failure to die " and don't have an adequate medical support system

to help them avoid that next hospitalization. I would NOT offer to be their PCP

but only their palliative care specialist (thus differentiating them from my FP

patients) and I would charge $100 a month for the phone access, willingness to

make home visits, but would charge insurances if/ when I make a home visit. I

could not handle very many of these, but might accept 20-40 patients total

($2000-$4000/month is not a bad compensation). I would also offer a sliding

scale for those who don't have the finances. There is a huge need for this and

nobody is willing to step in to help people in the chasm between home health and

hospice for bed bound/ home bound patients.

So this is the kernel of an idea. Please tell me your impressions or if any

docs are already doing this.

Stew Mones MD

Eugene, Oregon