There's a Doctor in the House

It’s a new-old idea: Physicians who don’t make you come to them—they come to you

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Schiffman’s house calls often involve more than examining patients. Here she helps Beverly Kay  figure out insurance paperwork for her husband, Robert, in the couple’s Rockville home. Photo by Laura-Chase McGeheeDr. Steve Simmons knew since age 4 that he was destined to become a physician. The Gaithersburg resident couldn’t, however, imagine the dissatisfaction he’d encounter when he actually began practicing medicine.

With financial pressures to squeeze as many patients as possible into a day, primary care “was an impossible job to do well and sleep at night,” Simmons says.

He switched from internal medicine to urgent care medicine but still felt disgruntled, due in part to wrestling with insurance companies. On his 40th birthday, “I caught myself wishing I was 65 so I could quit practicing medicine.”

He didn’t, of course, but in 2008 he joined DocTalker Family Medicine, a Vienna, Va.-based practice that offers house calls. Founded seven years earlier by family doctor Alan Dappen, DocTalker accepts neither Medicare nor private insurance. Simmons says that frees him and his colleagues to focus on the doctor/patient relationship.

DocTalker charges new patients a one-time fee of $500. According to the practice’s website, DocTalker physicians charge $400 an hour or $33.50 for every five minutes. If patients can’t afford the entire cost, Simmons says, they might agree to pay $20 a month for years to cover it.

Simmons, who is married to an emergency medicine doctor, empathizes with adult children who ask him to check on their elderly parents because they don’t live nearby. His parents live in Tennessee, and his 84-year-old father, a retired college professor who spoke many languages, has dementia. Simmons has been unable to find a doctor who will make house calls to see him.

In Montgomery County, Northern Virginia and the District, the demand for house calls has been so great that Simmons went from occasional house calls when he first joined DocTalker to as many as six a day while also continuing to see patients at the office.

House calls can reveal much more than what can be learned in an office visit, he says. “I get to see if the house is clean, if the person’s groomed, if there’s a fall risk. I see the complete picture when I go in the home.”

No longer, Simmons says, does he dread going to work. “I get to get up every day and, for the first time, I get to do what I was meant to do.”

Like Simmons, Dr. Stephen Kinney was tired of feeling rushed with patients. He worked as a family practice physician at a primary care clinic in Easton that was run by a corporation he declines to name.

“You’ve got to see patients, more patients, more patients,” says Kinney, a North Carolina native who now lives in the District.

In his mid-50s, he didn’t want to give up medicine, but he wanted to slow down. So in November 2011 he launched Metro Direct Care Medical in Chevy Chase. It’s just him and business partner Patrick Lodise, who drives Kinney to appointments in private homes and hotel rooms.

Also like Simmons, Kinney accepts neither Medicare nor insurance. “I worked for a company that took every insurance known to mankind,” he says. “I spent 50 percent of my time on the phone arguing with insurance companies. That’s why I decided I’m going to do this on my own.”

Kinney, who sees Montgomery County patients within the Beltway, calls himself “the MacGyver of house-call medicine,” referring to the television show that went off the air 20 years ago. MacGyver, a secret agent, was able to solve complex problems with the tools at hand.

MacGyver’s tools included duct tape and a Swiss Army knife; Kinney, who focuses on patients 18 and older, can perform a variety of assessments in patients’ homes, testing for urinary tract infections, for example, with what he carries in his car.

He doesn’t charge patients an upfront one-time fee and bills as little as $50 a visit for patients who live near him. A new patient visit typically is $150. “I had to undercut as a way to get patients,” he says.

For now, Kinney supplements his income by working under contract in a medical practice office.

“This is an experiment for me,” he says of Metro Direct Care Medical. “If it works, it works. If it doesn’t work, I’ve given it a good effort.”

Dr. Leila Hall, with her 4-year-old son, Grant Lebar. Photo by Laura-Chase McGeheeDr. Leila Hall’s patients are at the other end of the age spectrum from her counterparts. The Bethesda pediatrician typically makes at least two house calls a week, usually to check on infants.

“I’m very passionate about helping new moms do the right thing for their babies,” says the 37-year-old Hall, whose practice consists of herself and her mother, Marilee Hall, who sits at the front desk. “I didn’t want my new babies and my new moms to have to come into the office, where potentially there are germs.”

Plus, she gets to see for herself whether the baby’s environment is safe.

She’s also the go-to pediatrician in her east Bethesda neighborhood, happy to see sick children if their regular pediatrician’s office is closed. That way, Hall’s neighbors “don’t have to drag their kids to the emergency room.”

Having an office practice that’s open while her 4-year-old son is in preschool and making house calls when needed is the perfect arrangement, Hall says. After all, most insurance plans don’t cover well-child visits in the home, she says, and kids need a lot of vaccines that must be kept refrigerated. When she makes a house call to a sick child, the parents pay the same co-payment they would at her office.

“It’s such a comforting thing to know the doctor can come,” Hall says.

As the mother of “virtual triplets,” Dalene Erickson agrees. The 47-year-old Bethesda resident grew her family through birth and adoption, so only about 10 months separate the oldest, 9, from the youngest, 8.

Erickson works two jobs, running a day care center in her home and teaching ballroom dancing at night. Hall has “made many house calls to my house, usually because somebody’s sick,” she says. “I obviously cannot leave my job during the day.”

Hall also has gone to Erickson’s house to administer flu vaccine. “She came right after school, so they didn’t have to miss any,” Erickson says, “and we didn’t have to sit in traffic and wait and wait and wait.”

Rita Rubin is a former USA Today reporter and lives in Bethesda.

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