Home-care doctors are on a roll 

A San Francisco doctor and entrepreneur is growing his house call business while others are cutting back.

What’s Dr. Jordan Shlain’s secret? His business, On Call Medical Group, doesn’t rely on Medicare or insurance for reimbursements. Instead, he charges patients up front and helps them file reimbursements insurance companies may or may not honor, depending on the plan. He said surprisingly many plans do reimburse 60 percent to 100 percent of the bill. Meanwhile, other providers have focused their house calls, if any, on very ill seniors reliant on Medicare for their health insurance.

Medicare increased its house-call reimbursement rates in 1998, spurring interest in the practice, but it is dropping those rates as its overall budget contracts, according to Constance Row of the American Association of Home Care Physicians. The reimbursement rates for 2007 are 7 percent to 8 percent lower than they were in 2006, she said.

"The rates overall would decline up to 34 percent by 2010, making house calls economically unfeasible under Medicare," Row said. "We are working with others to try to educate Congress."

Kate Fullerton, physician’s assistant to Dr. John Fullerton of San Francisco, said he has cut back on his house calls because of the reimbursement issue, asking all but their most home-bound patients to come into the office. Such is not true of Shlain’s firm, which doesn’t rely on Medicare. It charges $255 and up for a new-patient house call, plus more after hours, at night or on holidays.

The model has proved so successful that Shlain has recently expanded his Bay Area practice into the Coachella Valley in Southern California, bringing on a doctor there. And he is in the midst of converting from a model with two partners and roughly four contracted doctors to a different system where doctors who have proved their interest in the company can become a partner and draw a salary with benefits for extra hours worked.

"In this type of practice you can’t be a clock puncher," Shlain said. "We’re available 24 hours a day. The more patients you see, the more you work, the more you get paid. In our model, the doctor gets paid for that, so they’re motivated to do the right thing. They get a bigger stake in the profit and pension-sharing, the harder they work."

Shlain started the firm in 1997 with a desire to create a practice with a superior doctor-patient relationship, where he needn’t see new patients every 10 minutes. He began the practice working on-call for the Luftansa airline, and then for Princess cruises. Today, some 20 percent of his work comes from cruise, hotel or other business referrals, he said. For example, he saw many norovirus patients this month after the Queen Elizabeth 2 cruise ship docked in The City. 

Joan, a 72-year-old patient in The City with a lung disease, told The Examiner that On Call saved her life after she refused to travel to see a doctor after her long-term physician retired and Joan’s health deteriorated. Her On Call doctor, Justin Davis, said he visits her regularly.

Bay Area doctors who make house calls

Here are a few local home-care doctors:

Bay Area House Call Physicians, Palo Alto; (650) 384-0986; www.bahcp.com

Dr. John H. Fullerton, San Francisco ; (415) 202-9990

Dr. Nirmala Kannan, Foster City; (510) 967-9567

On Call Medical Group, San Francisco; (415) 732-7029; www.sfoncall.com  

The Total Care Practice, Palo Alto; (650) 326-0840; www.thetotalcarepractice.com

*Some of those listed only do calls for existing patients or have other restrictions. Contact individual physicians for details.

Examiner research, www.aahcp.org and www.simpd.org

 

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A daily newspaper covering San Francisco, San Mateo County and serving Alameda, Marin and Santa Clara counties.
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