003 - Home Visits in Pediatric DPC

003 - Home Visits in Pediatric DPC

Listen to Marina and Phil discuss the ins and outs of managing your own Pediatric DPC practice. Today we'll review how to manage home visits. Thanks for listening!

 

00:00.00

Phil Boucher

Everyone welcome back to another episode Today. We are going to talk about home visits and if you had told me five years ago that I would be packing up my stethoscope and my scale and going to people's houses to see their babies I would have said that you're crazy because I just assumed that wasn't a thing that you can do. Um, and in the meantime I started a dpc practice and I get to do home visits and I love it. It's like the best part ever and so I want to hear from you first marina what do do you do home visits and what do those look like for you and then we can talk about how home visits can work in pediatric dpc.

 

00:38.34

marinacapella

Yes I do home visits and I really enjoy doing home visits I don't do very many of them though. So I offer them for newborns or for kids with special needs who would have trouble leaving the house or would be too anxious in the clinic environment. Um.

 

00:50.22

Phil Boucher

Um.

 

00:55.29

marinacapella

Also like I have a few select families who have decided to pay a higher premium sometimes because of their jobs or somewhat celebrity status or something like that where they don't want to be leaving their house too much. So yes I do home visits I love them. It's been fantastic I Definitely has to kind of figure out how to like.

 

01:00.65

Phil Boucher

Um.

 

01:13.57

Phil Boucher

Yeah.

 

01:14.18

marinacapella

Pack up all my supplies and make things portable. It's like oh how do I measure height you know at a home visit and I found this little ultrasound thing where you can just kind of put it against the wall on top of the kid's head and it measures the distance to the floor. Yeah, so so you figure it out and it's actually really fun to see.

 

01:18.12

Phil Boucher

Rate rate. Oh yeah, like a laser sort of thing that's cool.

 

01:32.88

marinacapella

Kids in their home environment and they get so excited that their doctor is coming to their house to see them So I love them I don't do them as much as other practices do but when I do them I Really enjoy them.

 

01:45.66

Phil Boucher

We started and I um was going I offered them initially for newborn visits for the first month of life so that looked like their newborn visit their two week visit and their one month visit in the home and we quickly paired back to just the newborn and the two week visit

 

01:58.44

marinacapella

Ah.

 

02:01.70

marinacapella

Yeah.

 

02:02.76

Phil Boucher

Um, mostly because of just the volume of visits increased to be too much and so we just scaled back our offering. We didn't change our promise to any of the patients that we had promised it to but we said for babies going forward. This is what we're going to offer and made sure that they were aware of that I mean all it really takes this update to your website to reflect that but we do.

 

02:05.80

marinacapella

Yeah.

 

02:17.66

marinacapella

Yeah.

 

02:20.79

Phil Boucher

Home visits for newborns and it is honestly one of my favorite things to do because like you said you get to see them in their home environment and the parents I mean first time parents don't even know what they're missing out on when they don't have to pack their baby up after just getting home from the hospital ghosted in a waiting room.

 

02:32.89

marinacapella

So.

 

02:36.35

Phil Boucher

Ah, have this snotty not kids you know, running around their baby and then go sit in the exam room and the baby needs to feed and the doctor doesn't come in yet like all the things in a typical fee for service practice. You get to avoid that you just show up at their house and they might have just fed the baby. The baby might be asleep. You get to meet their dog and cat. 1 of the things that we had to add to our um, little. Go bag that we take with us on home visits is a lint roller for all of the dog and cat hair because that was not something that we anticipated when we did that but we love doing home visits. We do them pretty much exclusively if it were newborns or like you said we have a couple of families where we will do them if their child has special needs or is medically complex.

 

02:58.11

marinacapella

Ah, ah yeah.

 

03:15.54

Phil Boucher

Or really struggles to leave the home for whatever reason so that's on more of a case- by case basis that will do that but otherwise families. Love the convenience with their newborn of doing that I mean I think a lot of Pediatricians feel like well how could you possibly do that. How would you get their weight. Will you just bring a scale with you like we just.

 

03:18.97

marinacapella

Ah.

 

03:35.10

Phil Boucher

Grab a scale from our room and take it with us. How would you get? ah their measurements you just measure them I think there is nothing special to measuring them in the exam room. How would you get the Billy well um, we just take ah ah a lancet like the heel lancet things and the little blood tube thing.

 

03:35.23

marinacapella

Yeah, exact. Ah yeah.

 

03:51.87

marinacapella

Um, yeah, yeah, you just pack it up though. Yeah.

 

03:53.57

Phil Boucher

I clearly know what all these things are called um and and do it if we need to like you just pack it up with you and go. There's nothing special about the office ah versus the home. You just take all those what what we do is if we do need to draw blood like for. Ah, Billy Rubin we just take the supplies with us and then we call the lab when we get back to our office and they have a courier that comes and gets it. We could also depending on what part of town they're in just drop it off on the lab on the way back ah to to clinic and.

 

04:10.61

marinacapella

Ah.

 

04:17.00

marinacapella

Ah.

 

04:19.47

marinacapella

Fast.

 

04:23.11

Phil Boucher

In terms of like working them into the schedule that sounds like it would be a big hassle if you're coming from a practice where you're seeing 30 plus patients per day how on earth would you get in your car and drive to somebody's house and see their baby and then drive back to clinic. Well when we have 4 to 8 visits per day. There's always room to add on a newborn visit.

 

04:28.53

marinacapella

Yeah.

 

04:40.98

marinacapella

Asked.

 

04:42.54

Phil Boucher

And the nice thing is too if you need to shuffle your schedule around. Um you just say hey so ands. So um, we just had a new baby born and we're going to need to do a newborn visit tomorrow. Would you mind coming at this time instead people are grateful. They're excited. They're like oh yeah, that's not a big deal at all and you know your patients Well enough, you know who you can ask or you know.

 

04:54.71

marinacapella

Yeah, yeah, exactly. Ah.

 

05:00.97

Phil Boucher

Who's going to be able to rearrange their day or who's already at home or whatever it might be that you know who to ask to say hey do you mind if we switch your appointment around because we got to see a newborn baby. Oh of course people are just excited and happy to hear about a newborn that's getting a newborn visit rather than grumpy that you're you're changing your schedule.

 

05:06.55

marinacapella

Yeah, yeah, exactly and you have that relationship exactly so they're more likely to think oh yeah and I know that Dr. You know Boucher would do the same for me if I needed it. So I'm you know, willing to like do this for somebody else that needs it? Yeah absolutely I will say that you just have to if you're doing home visits. You have to factor in the time because it takes time.

 

05:25.26

Phil Boucher

Right.

 

05:38.47

Phil Boucher

Um, yeah, right right.

 

05:39.87

marinacapella

To pack up all of your supplies. You have to anticipate your needs am I gonna need a strep swab am I gonna need blood. You know blood draw supplies am I gonna need you the the baby scale or the child scale like what? what am I gonna need and you kind of have to pack up your stuff so that takes time and then driving of course to the families' home. Some of them live near some of them leave live bar.

 

05:48.36

Phil Boucher

Right.

 

05:59.85

marinacapella

You can decide what your radius is that you're willing to go out and see right and you can decide if you charge more for a family outside of a certain radius. That's all up to you? Um I'd say there's so many different ways of doing home visits some dpc Pediatricians just start out doing only home visits in order to save.

 

06:00.11

Phil Boucher

Right.

 

06:06.58

Phil Boucher

Right.

 

06:19.64

marinacapella

On the cost of having a physical location and then eventually once they grow and once they're making money then they decide to have a physical location. There are a select few Pediatricians who only do home visits and that's just how they want to have their practice forever and that's okay, it's their practice. Um.

 

06:19.75

Phil Boucher

Um, in my.

 

06:30.86

Phil Boucher

Right? That's their model. Yeah.

 

06:37.91

marinacapella

I have I share my clinic with another dpc Pediatrician and her model is based on home visits. Her practice name is as be home pediatrics with Bee wonderful and she's really happy with that She has to do a lot of driving I decided for me I don't want to spend my life driving a lot and so it was.

 

06:42.77

Phil Boucher

I do.

 

06:54.50

Phil Boucher

Yeah.

 

06:57.61

marinacapella

Important to me to do some home visits but really limit the number of home visits that I do because I just don't like spending too much time in the car personally but you get to decide What's right for you? yeah.

 

07:06.45

Phil Boucher

It does add some stress. It does add some stress like the just the juggling act of okay I'm going to get to the home like I told Marina as we started recording this like I'm leaving for a home visit literally as soon as we're done.

 

07:20.17

marinacapella

Yeah, ah right? Ah yeah.

 

07:21.74

Phil Boucher

Taping here and it does add stress because then you have to think alike about getting back to the office and the next thing that's coming up So for me like we typically do one home visit max per day and most days we don't do any home visits because we just don't have a newborn that needs a home visit on any given day. But if they stack up then that will create a lot.

 

07:29.84

marinacapella

Yeah, yeah.

 

07:36.85

marinacapella

Um, yeah, ah.

 

07:39.64

Phil Boucher

More stress. But I think if you're intentional about that and you just adjust and wiggle as you need to then patients understand and they're super excited about the prospect of any I mean they're excited that they're able to contact you to get into your office when you need to be seen that you're accessible that you're friendly that you know them and so.

 

07:45.29

marinacapella

Ah.

 

07:56.50

marinacapella

Yeah.

 

07:57.75

Phil Boucher

The home visits is just like icing on the the cake that they already get for being a part of the practice and so patients love them and honestly I don't know about you but they're the fastest visits ever when I actually like am seeing the patient Because. We just chat while we're like getting set up. We're getting the scale Out. We're finding out you know how feeding's going all those sorts of things feeding's going Well Blah Blah Blah Blah Blah They are super quick visits because you haven't layered on all the context of them having to come wait in the waiting room and being in the midst of feeding and being stressed out like when the parents aren't stressed.

 

08:15.51

marinacapella

Um, yeah.

 

08:27.90

marinacapella

Um, yeah.

 

08:31.37

Phil Boucher

There's so much less um to to talk about or to talk through because they just feel so much more comfortable.

 

08:36.36

marinacapella

Yeah, that can go both ways though. Sometimes it's quick for me if it's like a sick visit but if it's a newborn visit I Feel like oh I'm in their home like I have to really go above and Beyond go through everything so that it really depends I think on your approach and the family.

 

08:52.53

Phil Boucher

That's true. It depends on the patients too. Yeah, like the one that I'm going to right now is the third born and I know it's going to be like okay they're growing well nice to meet your cat by like yeah, ah.

 

08:56.38

marinacapella

And the paid. Yeah, all of that stuff. So um, yeah.

 

09:04.62

marinacapella

Yeah, thanks that exactly? Ah, yeah, first babies are going to take a lot a lot longer because they have a lot more questions to answer. Yeah and my clinic partner Margie who does the the home visits.

 

09:10.74

Phil Boucher

Yeah, for sure.

 

09:18.31

marinacapella

It's interesting because you know her her families do pay probably double of what my members pay because she has to factor in all that extra time and driving and everything and the extra level of access but sometimes patients come to the clinic. So if they live nearby and they're like oh no.

 

09:22.77

Phil Boucher

Um, right.

 

09:35.47

marinacapella

Ah, you know you don't have to come to our house. We'll just stop by the clinic. This is something super easy. So this kind of even though you know it's included in her her package sometimes people come to the office and sometimes they just want to get out of the house and that's totally fine. Yeah.

 

09:40.73

Phil Boucher

Yeah.

 

09:46.95

Phil Boucher

Totally I think you could even be like hey I can come over this afternoon at three o'clock or do you want to swing by the office at 11 and like we'll just swing by the office. Not a big deal. That's a good way to like honor what you've promised with the the home visits but also to make it so that like if it's more convenient to the family or if they don't really care either way.

 

09:56.78

marinacapella

Ah.

 

10:06.81

Phil Boucher

They could just come by because it is. It is nice honestly to have a home base where you're not constantly driving and figuring out how you're going to get from this side of town to that side of town all day long like I would struggle with that a lot and not dropping things and so that's why I like having the home base as our main operation.

 

10:13.51

marinacapella

Um, yeah.

 

10:22.21

marinacapella

Yeah, definitely yeah 1 quick question I want to add on before we close up is what about malpractice insurance. Do you have to make sure that home visits are covered.

 

10:24.41

Phil Boucher

And then having the home visits as a little bit of icing for newborn parents.

 

10:40.10

marinacapella

When it comes to your insurance.

 

10:40.20

Phil Boucher

My understanding is yes that you do although I'm not I think it varies by state to state and so that would be something that you would have to talk to your malpractice carrier about specifically. I Don't want to say that you might just ask for permission or forgiveness and not permission because that would probably get people in trouble. But I think if you just talk about how your your practice model is then I would probably not get into too much the dignity grity of it. But I mean what's what's your experience with that.

 

10:58.64

marinacapella

Ah, yeah, ah.

 

11:08.72

marinacapella

Ah, yeah, ah yeah I just aired on the side of caution and when I signed up for my malpractice insurance I Made sure to mention that like my practice will include home visits and so it ended up being okay but I've heard stories.

 

11:19.16

Phil Boucher

Yes, that was what we did to I have heard stories that too.

 

11:26.37

marinacapella

Yeah I've heard stories where people say oh my malpractice carrier won't won't include those or won't cover those for whatever reason I mean but there are so many malpractice carriers to choose from just look for one that includes it. Yeah, you'll find it so I wouldn't say that's a big fish.

 

11:33.11

Phil Boucher

Right? Yeah, you can find 1 right? Yeah, we did that too because I didn't I didn't want to be but I I didn't want to like you know, have to ask for forgiveness on malpractice that's kind of a big thing to ask for goodness on. But.

 

11:45.98

marinacapella

Yeah, exactly.

 

11:50.11

Phil Boucher

I have heard that in a lot of the Facebook groups of late that the idea of the home visits is doing that. But there's a way and that's the nice thing about dpc is like every dpc practice is unique and there's always a path forward even if it takes a little bit more of figuring out or.

 

11:56.50

marinacapella

There's a way.

 

12:04.85

Phil Boucher

Finding a malpractice cover carrier that will cover the specifics of the way that you do things Awesome! yes.

 

12:07.60

marinacapella

Yeah, definitely all right? So yes, and so final. Ah, final say is yes, home visits are possible within pediatric dpc and I would say every pediatrician that I've talked to who does them loves them but the number that you do is completely up to you all right.

 

12:19.81

Phil Boucher

Absolutely yep.

 

12:26.13

marinacapella

Thanks for listening everyone until next time.