Medical practice melds past with future
Author: Steve Thompson, Correspondent
October 16, 2002
CHAPEL HILL -- The good old days when doctors made house calls may not be gone after all. A new local medical practice is betting those days are on their way back. For patients who want to be seen by one of the new practice's doctors, there's no office to go to and no waiting room to sit in; the doctor comes to you. Doctors Making Housecalls is one of the nation's first modern medical practices dedicated exclusively to making house calls. It was founded recently in Chapel Hill by Dr. Shohreh Taavoni, who recently left Raleigh's Capital Family Medicine, where she had practiced since 1995. What sort of vehicle will she show up in for an appointment? "It's called a car," said her husband, Dr. Alan Kronhaus, with a laugh during a recent interview. Kronhaus is directing the management side of the new business. He said virtually all the services a typical family doctor provides from the office these days can be performed out of an old-fashioned medical bag. Advances in medical technology were one factor that led to the demise of house calls during the 1950s. Now it is further technological advances, according to Kronhaus, that have made them practical again.
These days, Kronhaus said, a doctor who wants an X-ray sends the patient to a radiologist. If a blood test is needed, the blood is sent to a lab. "Now we have sonography, we have CT scans, we have MRI and so on -- none of which is done in a physician's office," he said. "These are things that are done either at the hospitals or in imaging centers."
Patients can be referred to these services from their own homes as easily as from a doctor's office, Kronhaus said. And those who don't need these services can just stay at home.
A blood sample can be taken in the patient's home and then preserved in a small centrifuge in the trunk of a car. "We can have the blood spinning as we drive down the road," Kronhaus said.
It was Taavoni who first came up with the idea of making house calls. Like many doctors, she has become increasingly frustrated with HMOs and insurance contracts.
When medical practices contract with insurance companies, they are forced to accept lower fees. This forces doctors to see more patients to make the same amount of money, and the quality of care often suffers.
Since Doctors Making Housecalls does not contract with any health insurers, its patients will have to venture out of their insurers' networks and pay more out-of-pocket expenses. The practice will file insurance claims for those whose policies cover the services provided. A $65 fee for scheduling the appointment, however, is not recoverable. Taavoni and Kronhaus hope the comfort and convenience of house calls will be worth the expense to many.
"I always felt that if I was a able to provide a service that others couldn't, then maybe I could get away from this whole insurance hassle," Taavoni said. "People are willing to pay a little more if they're getting a service they couldn't otherwise get."
Of course, if getting a doctor to the house proves as difficult as it can be to get a carpenter, painter or the cable guy to come by, house calls may not turn out to be so convenient. But Taavoni and Kronhaus predict they can do better.
"Responsiveness is going to be a key aspect of our service," Kronhaus said, "that we will always have to be in a position to be responding within either the same day or the next day."
A typical practice is limited by its fixed amount of office space, Kronhaus said. It can't easily add doctors because there is nowhere to put them. "As the practice gets busier and busier," he said, "the only way that the organization can respond to it is by scheduling further and further out".
"For us, when we get busier we just add people," Kronhaus said. He believes the advantages of not having an office will help them recruit doctors fast enough to keep pace with demand.
One of these advantages is flexibility. "It doesn't matter very much to us whether the physician wants to work three days a week or six days a week," Kronhaus said. "Or whether it's six months a year or 10 months a year."
Kronhaus and Taavoni have had a high-tech computer network set up that will allow doctors to work from their homes inside a sort of virtual practice.
"Everything is computerized," Taavoni said. "We're going to have electronic medical records, electronic everything."
Patients call a small, central, business office to make an appointment. From there, records are generated and received online so that the doctors can access them from their home computers.
"At the beginning of the day," said Kronhaus, "the physicians go to their computers and download their schedules." Kronhaus and Taavoni believe that combining house calls with this concept of a virtual medical practice will be a winning formula for doctors and patients alike.
They expect the convenience of house calls to attract a broad range of patients ranging from bedridden elderly to overworked executives to ailing housewives busy at home with the kids.
If the idea catches on, it won't be Kronhaus' first such success. In the early 1980s Kronhaus started KRON Medical Corp., an agency that provided doctors to medical practices and hospitals that needed them to fill in temporarily. By 1992 the company had annual revenues of $25 million.
His idea also spawned what is today a billion-dollar industry known as "locum tenens," which is a term used in healthcare to describe one doctor covering for another.
In 1993 KRON was acquired by Continental Medical Systems Inc., one of the nation's largest health care providers. Two years later Kronhaus retired to become a stay-at-home dad to his and Taavoni's two children.
Kronhaus decided to leave retirement back in April when his wife came up with the idea of Doctors Making Housecalls.
Kronhaus says he hasn't seen patients since 1990. When asked if he would soon be making house calls, he replied with a laugh, "For the patients' sake I hope not. I'm going to stay on the management end."
Taavoni, on the other hand, has already made several house calls and is ready to jump into her Honda Odyssey on a moment's notice. "Everything has taken a long time to set up," she said, "but for months I've been ready to go."
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