3 Must Haves for Home Visits: Pediatric Direct Primary Care

Direct primary care pediatricians enjoy the freedom and flexibility to care for patients in a way that suits their values and approach. Many choose to offer home visits—either as their primary service or as an additional option within an office-based practice. Whether your practice focuses entirely on home visits or includes them as a smaller part, it’s important to consider a few key factors before moving in this direction.

Portable Tools

When you offer medical care through home visits, you’re essentially bringing your pediatric office into the homes of your patient families. This means you need to plan ahead and bring all the necessary tools and equipment to complete each type of visit. When I ran a home-visit-only pediatric practice, I organized my supplies into three categories:

• Well child visits (some supplies were different for babies < 2 years old)
  
• Sick visits
  
• Procedures
  

This system helped me lighten my load by packing only what I needed for the specific type of visit. Since many supplies overlap between categories, I kept a separate bag with those shared items and brought it to every visit. You can read more about my home visit bag checklist here.

Sensitive Exams and Subjects 

As a full time home visit only pediatrician, I needed to consider how I was going to accomplish sensitive exams and address sensitive subjects as home visits. While the scope of pediatrics is such that you likely won’t be doing full pelvic exams on patients, you will certainly need to examine sensitive areas of the body of kids. 

If you are the only employee in your practice (like I was), you especially need to consider how you will perform these types of exams. My strategy was simple and straightforward. I made an examination of sensitive areas a part of every well child exam so that my patients and their parents would expect it. I examined the rest of their body first and then stopped to talk with the child before I got to the sensitive part of the exam. 

First, I discussed with both the child and the parents what I was looking for and how I was going to look. Then, I gave the child the ability to have control on how they were going to let me see the parts that I needed to see. And lastly, I looked the child in the eyes and told them that “the only reason why I was looking at their private areas was because I was a doctor and that their parent(s) were present. No one else should be allowed to look.”

After the exam, I documented that conversation in the child’s medical chart and made sure to include that the parent(s) was present and aware that I was examining their child. While this method is not perfect in eliminating all of your risk, it worked well for me and the families that trusted me. 

Insurance Coverage 

Physicians are often surprised by the different nuances to insurance coverage when it comes to direct primary care in general and home visits in particular. This is a question that comes up often in our private Facebook groups, so I thought that it would be helpful to address it here.

Insurance companies need to assess risk differently if you are offering home visits vs traditional office visits. This affects all areas of insurance coverage. 

• Malpractice insurance
• Commercial automobile insurance
• Business owners policy 

Malpractice Insurance

For malpractice insurance, not all companies will write a policy for a doctor who is planning to do home visits only. Part of the reason is that as a solo physician, you won’t have the benefit of having someone else witness your patient interactions. This increases your risk of being accused of wrongdoing. In addition, it is more difficult for the insurance companies to account for the risk of you conducting visits in someone’s home rather than an office setting.

Inability to clearly account for the risk involved in home visits is also the reason why it is difficult to obtain a business owner’s insurance policy as a home visit pediatrician. When you are at a different setting everyday for a patient visit, the insurance company has no way to be able to rate your risk in each individual setting. As a result, keep in mind that you may be at risk for liability if you accidentally knock over someone’s expensive vase or damage their walls with your medical equipment, etc. This is something to consider when you are setting up your practice. 

In order to understand what your malpractice policy limits should be, you can watch the webinar that my insurance agent husband recorded for DPC Pediatrician Academy. 

Commercial Auto Insurance

Commercial auto insurance is also something that you need to consider when you are practicing exclusively home visit direct care. If you purchase your car through your business and the title of the car is in the business’s name, then you need to have a commercial auto policy. During my last two years of my home visit practice, I purchased a car through the practice and bought a commercial insurance policy.

These policies are often more expensive than a personal auto policy, but the coverage limits are greater. I was certainly glad for my larger policy limits when I was in a terrible car accident on the way home from a patient visit in 2023. My brand new car suffered several thousand dollars worth of damage and my commercial policy covered it all (besides the deductible). 

While it may be easy to understand that if your car title is in the business’s name, you need a commercial auto policy, there are other times where it may not seem so straight forward. If you are driving your personal vehicle and using it for both personal use, but also business use, your personal auto policy may not cover you if you are in an accident while you are commuting to or from a home visit.

When you are using your personal vehicle for business use, it is wise to purchase a commercial auto policy. Otherwise, if you are in an accident and the insurance company discovers that you are using your personal vehicle for business use without a commercial policy, they have the right to deny your claim and/or cancel your auto policy. 

Lastly, if you “advertise” your practice on your vehicle, you need a commercial auto policy. This includes magnetic signs that tell people about your practice all the way to full vehicle wraps with your logo and information on it. If your vehicle is a “rolling advertisement” for your practice, you need to be covered by a business policy that will protect both you and your vehicle. 

Final Thoughts

As a home visit only direct primary care pediatrician, I chose home visits only as a way to keep my practice overhead low. When I started my practice, the idea of direct care pediatrics was still pretty new and not many people had heard of this way of practicing medicine. Therefore, I wanted to decrease my risk by not having a large sum of fixed monthly costs in the form of rent or lease payments. In addition, I needed to consider how to bring an entire pediatrician’s office to people’s homes and how to conduct sensitive exams in a respectful and less risky way. 

Whether you are considering adding home visits to your practice vs having an exclusively mobile practice, you just need to account for some of the added expenses of things like portable equipment and insurance premiums. Talk with pediatricians who have gone before you and can guide you in the process of setting up this type of practice. In addition, professionals like a lawyer and a trusted insurance agent are important to find so that you can be protected from potential risks.