We offer rapid response for all palliative care requests. Patient comfort and dignity are our first priority. We will complete the necessary paperwork for hospice homecare referral, and will assist patients in locating a quality hospice service. We can arrange for immediate hospice medication for patient comfort.

Why Patients and Their Families Call Us

Patients, families or friends usually call us when there is no established primary care physician available, and the patient has become physically ill and is suffering. In some cases, patients have already pondered the decision for hospice care. In other cases, we are asked by family or friends to help them with this decision process. With a physician housecall, ample time is made available for thorough communication and decision-making by all those involved. If hospice is determined to be the best option, orders are written and a hospice service is then contacted immediately. In many cases, hospice home care providers may arrive same day to begin the process.

In some cases, a patient with an established primary physician will suddenly become ill when the provider is unreachable. In these situations, if hospitalization is not wanted, we will begin the hospice process until the primary physician is available to resume medical direction. We will communicate with the primary doctor in these situations when possible.

Our Promise to You

We are highly experienced with palliative and hospice care, and understand the challenges that are faced when making the decision for this option. We will use empathic communication to resolve conflict and lessen ambiguity. We respect patient’s wishes to maintain dignity and to forgo life-sustaining treatment.

We are frequently asked to evaluate patients with UTI or urinary tract infection. Most younger people with this problem experience symptoms such as painful and frequent urination, along with urgency or the feeling that one needs to urinate. These symptoms usually suggest infection of the lower urinary tract. Kidney infection, or pyelonephritis, may present with these symptoms in addition to flank pain, nausea, vomiting and fever. However symptoms may vary among patients, and in the case of older patients, and those with certain medical conditions, such as diabetes, the symptoms of serious infection may be minimal. Simple urinary tract infection can progress to sepsis or overwhelming or life-threatening infection, so it is important to seek urgent evaluation and/or treatment for all cases of UTI.

Call Your Doctor vs. Clinic or ER

For some patients with recurring infection, a simple phone call to their primary physician may be all that is needed to initiate a telephoned prescription for an antibiotic at a nearby pharmacy. In California, out-of-state licensed physicians may call in prescriptions for their patients who are visiting here. For patients without access to a primary care provider, several local clinics are available for urgent care. It is best to call for an appointment before going, in order to minimize potential waiting room time. Hospital emergency rooms can always provide urgent care for these kinds of problems, and they do so frequently. Insurances can usually be billed directly when patients go to the ER, however for those without adequate coverage, the emergency department is always the most expensive option, unless sliding scale fees are offered. Patients risk increased exposure to other illnesses in any public medical waiting room.

The Housecall Alternative

Urgent care housecalls offer the most convenient and patient friendly option. Our patients with urinary tract infections report to us that they request our services because they feel more comfortable staying at home or in their hotel room with easy access to the bathroom while awaiting the doctor’s arrival. Also, because we dispense antibiotics and other appropriate medications, there is usually no trip to the pharmacy required. In most cases we may perform a urinalysis dip test with results available on scene within minutes. Urine cultures may be taken and delivered to the laboratory for processing when needed. Exposure to other sick patients is not a significant risk with medical house call services. Most insurers offer reimbursement for housecalls, but to varying degrees, so it is important to check with your insurer regarding your coverage prior to requesting a house call doctor visit.

Other Urinary Problems That We Are Called To Treat

Occasionally, we are asked to see patients with urinary retention, or inability to urinate. We carry the necessary equipment used for simple cases of this problem, however, because we cannot guarantee rapid response and are subject to traffic conditions, we usually recommend hospital emergency room care. Patients with urinary retention are treated quickly in the ER to relieve them of their misery.

We are asked to place foley catheters by patients who are mobility challenged or unable to go to the clinic for varying reasons.  We carry the necessary equipment and sterile technique is always used during the housecall visit.

Painless hematuria or blood in the urine without other symptoms is usually evaluated by laboratory analysis of the urine.  We can arrange for this to be done, however the tests will be run be a separate laboratory and therefore not available during the housecall.

For patients with suspected kidney stones, ER evaluation is required since immediate radiologic imaging may be required to confirm an accurate diagnosis.

As always, we recommend that any patient with a serious or life-threatening condition go immediately to their nearest hospital emergency room, or call 9-1-1

Urgent Med Housecalls offers mobile urgent care for children of all ages. Services are offered 24 hours a day, 7 days a week throughout the San Francisco Bay Area. Rapid response is available upon a first-to-call basis. Appointments are not required. Night services are available for our established patients and clients, and in many cases are available to first time requesters. Our board certified emergency physicians are highly experienced practitioners of pediatric emergency and urgent care, so that your child’s care is in competent hands. Most of our providers are experienced parents as well.

What We Bring to You and Your Child

Our physicians carry mobile medical equipment specifically designed for pediatrics. Smaller sized blood pressure cuffs and appropriate temperature measurement is available. Orthopedic splinting for smaller children is available, as well as suturing (stitches) capability. Pediatric medications are brought to you so that a trip to the pharmacy is usually not necessary. For those who prefer to obtain medications from the pharmacy, we offer written or telephoned prescriptions.

Pediatric Problems that We Commonly Treat

Most requests for pediatric urgent care service that we receive involve sore throat, earache, cough, fever, vomiting, minor cuts and sprains. For children who require procedures such as wound repair or stitches, the child must be able to cooperate for the procedure since our doctor’s are working solo and an extra set of hands to help hold the child will not usually not be available. We accept patients with other illnesses and injuries upon a case by case basis. If your child sounds potentially serious ill we will always refer to your nearest emergency room or pediatric emergency department when available. When we do evaluate and treat your child, with your permission, we will communicate with your primary pediatrician to help optimize followup care.

The Pediatric Urgent Care Housecall Advantage

Our services are requested by parents for a variety of reasons. Perhaps most commonly we are called by solo parents or child caregivers who have multiple children to supervise. Taking more than one child to the doctor’s office, clinic or emergency room, and then having to travel to a pharmacy is always a chore. Many parents prefer to avoid public waiting rooms because of the potential for exposure to other illnesses. Waiting hours for medical care with a small child in the public space setting is disruptive to the child’s natural eat/sleep rhythms. Intoxicated and/or behavior-challenged adults can pose a safety hazard for children and other persons in the public waiting rooms and other spaces of many emergency departments.

For serious or life threatening conditions, call 9-1-1 or go to your nearest hospital emergency department.

We offer rapid turnaround, usually same day, of physician’s report for RCFE.  These forms, according to California law, must be completed for all residents, or prospective residents, of residential care facilities for the elderly licensed by the California Department of Social Services.  These reports require that a history and physical examination be completed by the physician or provider, along with a tuberculosis skin test which takes 2-3 days to obtain results, or a chest x-ray to rule out active pulmonary tuberculosis.  For patients who need these forms completed quickly, the chest x-ray provides the best option.  Once our doctor has evaluated the patient, a portable x-ray machine may be quickly brought on-site to the patient and images are then available usually within 1-2 hours thereafter.  The completed and signed form can then be faxed to the facility or other requester.  For patients who are not in a hurry, and who would prefer to avoid the x-ray and associated radiation, a skin test is performed by subcutaneous injection of purified protein derivative or “PPD” and then measurement of any rash or reaction is performed 48-72 hours later.  If it is determined to be non-reactive, then the report is completed, however a positive reaction will require a followup chest x-ray.  We offer these rapid turnaround services throughout the San Francisco Bay Area and the Monterey Peninsula.  Fees will be based in large part upon travel time of the nearest physician providing the service and are not covered by Medicare or secondary insurers.  The chest x-ray, if done, may be billed entirely to Medicare.

Thanks to modern handheld eye care technology, for patients with urgent eye problems, such as injury, infection, and even particles stuck in the eye, physician house calls can now offer full spectrum care. The key to adequate evaluation for these problems is the ability to perform a detailed examination utilizing several instruments, including fluorescein staining with microscopic visualization under a wood’s(cobalt blue) lamp in order to visualize corneal injury or disease, and slit lamp examination of the anterior chamber or front compartment of the eye. The slit lamp found in most emergency departments and ophthalmology clinics consists of a small table about waist-height on wheels. The instrument itself sits on top of this table and typically about 2 feet in height. While this standard slit lamp is too cumbersome to be carried to the patient at home, several smaller handheld devices are now available for this purpose. These handheld units have the added advantage that they can be used to examine patients who are recumbent or lying down, unlike the table-top slit lamp which requires the patient to sit upright in a chair. Additionally, visual acuity should be checked for every patient with an acute eye problem when possible. Paper eye charts may be carried, however eye chart apps now exist so that a smart phone can be used for this purpose. Ability to check intra-ocular pressure is important for patients at risk for glaucoma and a standard handheld ophthalmoscope should always be carried for examining the posterior chamber of the eye, including the retina. One last item that is useful to carry is the ophthalmic burr which may be used to remove foreign objects and even rust stains from the cornea, however this device should only be used by persons with adequate training and experience.

Helpful Hints for the Patient

Patients with pink eye or conjunctivitis should inquire beforehand what the doctor uses for eye examination. Fluorescein staining and cobalt blue examination under microscopy should always be available. If the doctor does not have this capability, seek your eye care elsewhere. For serious eye emergencies, call 9-1-1 or go to your nearest hospital ER.

Example of a house call for an eye problem

Ellen experienced a scratchy sensation in her left eye suddenly one morning. She noticed some redness of the eye, and had some crusting that morning in her eye upon awakening. She was not sure if she had scratched her eye the night before when she was out drinking with friends. She did not feel like sitting in the ER for hours waiting for care because she had things to do that day. She telephoned to inquire about house call service and after discussion with the physician she requested a visit. The house call physician arrived at the agreed upon time and after introductions then proceeded to evaluate Ellen. An appropriate problem specific medical history was taken, and eye exam then performed. In addition to checking visual acuity with an eye chart app on a smart phone, the physician then applied eye drops to prevent pain during the exam and then stained the eye with fluorescein. A cobalt blue lamp was used to visualize scratches to to cornea, and to check for certain more serious infection, and close inspection was performed to be certain that no objects such as dirt or sand were embedded anywhere in the conjunctiva or cornea. It turned out that a small particle of sand was found embedded in the cornea, and this was easily removed with a burr by the house call doctor. It was done painlessly because of the anesthetic eye drops already instilled. Ellen received medication prescriptions for eye drop antibiotics and for analgesics to use just in case she experienced significant pain after the house call visit. The exam and treatment were complete within about 30 minutes of the physician’s arrival, and paperwork finished after another 5 minutes. Ellen was provided instructions for aftercare and was advised to call the house call provider anytime, 24/7, should she experience problems or have questions. Ophthalmologic specialty evaluation would be arranged if needed.

Most USA PPO insurance providers cover physician housecall services to some degree. Because of the nightmarish coding rules, complex paperwork, and frequently delayed payments to physicians by many insurers, we have opted to remain out-of-network for all USA-based companies. This allows us to keep fees lower, and to focus more on our patient’s care, rather than spend much of our efforts just trying to get paid for the care we have already provided.

Also, the fees allowed by insurers for in-network (contracted) providers cannot sustain an urgent house call practice of this nature, at least not here in the San Francisco Bay Area, where the cost of running a medical practice one of the highest in the nation. We therefore currently require payment for our services at the time of service for all patients who are insured with these providers.

How to Pre-Determine Your Insurance Reimbursement

To estimate your potential coverage for medical house call service you will need to know what remains unpaid of your annual out-of-network deductible. Essentially this deductible must be satisfied in order for reimbursement to occur. For example, some deductibles are perhaps $100 or $200, others may be $2000 or even $7000. After the deductible is met by the patient, most PPO insurers will reimburse up to 80% of house call medical costs. Some companies refuse to pay for after hours services or for physician excess travel. If limiting your financial outlay is your first priority when arranging medical care, we recommend that you contact your insurer directly to determine what is covered.

Insurance Claim Form Submission by Patients

We found, after offering to submit claims as a courtesy to our patients for a period of time, that the patients who submitted claims themselves were reimbursed more quickly. When we submitted the claims, the insurers tended to argue with us about coding not being done according to their individual company requirements. This delayed patient reimbursement significantly. Insurers are usually eager to argue about insignificant coding details with the medical practitioner. It is much different for the patient in most cases, since patients usually choose the insurer, thereby bringing value to the insurer. So when patients simply mail in their claim forms to the insurer, reimbursement tends to occur more quickly.

Insurance Reimbursement Strategies: What Patients Should Know

Most US PPO insurers want to keep your money as long as they possibly can. They are very savvy at doing this. So, which patients get greater reimbursement?, and who is reimbursed more quickly? The person who plays hard-ball once the insurer gives the first hint of being difficult tends to get more, faster. My patients who get their money fast tell me that they get on the phone and “give ‘em hell!”. Being “nice” is worth a try at the start of the first call, but thereafter, this niceness can only work against you, according to many. Successfully reimbursed patients advise that if you call the claims office daily, or even twice daily, and talk to them like you mean business, you will get your money more quickly. Claims processors are banking on the “niceness” and politeness of most patients. So if your reimbursement is important for you, it may be worth trying this approach.

For company employees insured through their work, the human resources department may prove invaluable when it comes to getting reimbursed. Remember that the insurers always cater to the HR staff since these people hold the purse strings for large group policy purchases. So first be pleasant, then not so nice, then go to HR, if available, to get the job done.

Occasionally, patients report that reminding the claims person that they will seek treatment in the ER the next time that they are sick or injured, instead of utilizing a more cost effective housecall service, can be persuasive.

Health Savings Accounts and Flexible Spending Accounts

Patients with high insurance deductibles often qualify to place money in these tax-deferred accounts. A tax advantage occurs, while satisfying the annual deductible, when paying for medical services using these accounts. Medical house call services qualify as acceptable medical expenses when using these accounts. Your tax advisor can keep you up-to-date on these rules as they apply to your individual situation.

House calls have made a real come-back in recent years, and so availability is becoming fairly widespread throughout the United States. These are important things to consider when searching for a house call practitioner.

The Search

While patients may use the American Academy of Homecare Physicians (AAHCP) website to search for providers who work with Medicare, online search engine queries for “housecall doctor” will now produce results for many locations throughout the United States.

A quick review of a physician’s website should reveal services offered, fees and insurance information. Be wary of websites wherein the individual providers are not listed. For these sites, always call to ask for a physician’s or other provider’s credentials before enlisting their services for your care.

Verify State Medical Licensure

Medical licensure sets the minimum competency requirements to diagnose and treat patients.  Check with your state medical licensing board to verify a provider’s credentials. For example, to check a physician’s license in California go to Medical Board of California.  Most states have similar user-friendly websites.

Is Your Doctor Board Certified?

Board certification demonstrates a physician’s “exceptional expertise” in a particular specialty and/or subspecialty of medical practice, according to the American Board of Medical Specialties.  Check with the ABMS to see if your doctor is board certified.

Non-Physician Practitioners

It is important to know if the provider is a nurse practitioner or physician assistant since their state licensing divisions are usually accessed on separate websites.  These “midlevel practitioners” have significantly less medical training than physicians, and so will usually be indirectly supervised by a physician.  Here in California, regulations require that a physician assistant always have access to communication with a supervising physician when caring for patients.  While many midlevels are competent and render excellent medical care, it is important to research these practitioners as well.

Online Physician Reviews

Sometimes a simple online search for a medical provider’s name with credentials will reveal important information. Other sites, such as Angie’s List, may provide helpful reviews, however these reviews must be considered carefully when gauging the competence of a medical caregiver. As it often seems to be with human nature, disgruntled patients tend to leave reviews more frequently than satisfied patients.

Also, know that some online review sites are notorious for manipulating ratings based upon whether the reviewee pays for advertising with them.

Safety First: How prepared is your house call provider?

We recommend that house call physicians offer medication injections only if adequately prepared for adverse medication reactions. Specific medications for serious allergic reactions and other problems should be carried by the competent house call provider who is familiar with their use. Ideally, basic airway equipment and even supplemental oxygen should be readily accessible when patients are treated in this way. Clinics, doctor’s offices and ER’s always have some capability to handle these situations. If you anticipate receiving an injection during the doctor visit, inquire as to what your provider carries for your safety. If the caregiver states that he or she does not need anything else because they have never had a problem treating patients with injectable medications, consider looking for a safer, more prepared, house call provider. While serious reactions are rare, they do occur. A solo medical provider who is not prepared, is inviting disaster. The death of a celebrity pop singer recently is a case in point.

Bedside Manner

Provider personality should be considered since medical outcomes are influenced by patient-physician communication. If possible, interview your potential candidate doctor first by phone, then in-person. Not all physicians will be accessible by phone for this purpose, but is is worth asking. Fortunately, because house call practitioners spend much more time with their patients than their office and clinic-bound colleagues, most tend to be socially adept.

People commonly refer to upper respiratory infections as the “flu”. This is used as a catch-all term, however true “flu” is caused by specific influenza viruses that affect the respiratory tract, usually with more severe symptoms, and can rarely cause death (0.1% mortality rate during each average severity seasonal epidemic). Worldwide pandemics occur occasionally, the most devastating occurring in 1918 when 40 to 100 million people died. Mortality rates during these pandemics can be much higher than the usual 0.1%.

Influenza viruses that can cause severe epidemic illness are the A & B types. While humans can develop immunity to these viruses either through infection or immunization, these viruses genetically alter their RNA from year to year, so that immunity is temporary. This is why influenza re-vaccination is recommended by the CDC on a yearly basis.

Influenza season typically occurs from November to April in North America. Peak season is from January to March. In our medical house call practice here in San Francisco, we see many travelers from the southern hemisphere including throughout South America. It is not unusual for us to diagnose influenza in the summer months in these patients, since they have come from their winter season back home.

Influenza Illness

• high fever (fever not always present)
• cough
• sore throat
• runny nose or nasal congestion
• headache
• muscle aches
• profound fatigue or weakness

Nausea, vomiting, diarrhea can occur with influenza, but are not typical symptoms of influenza. “Stomach flu” is a catch-all term used to describe illnesses that include these symptoms, but does not specifically refer to influenza.

Influenza illness usually lasts a few days to 1 or 2 weeks. Occasionally complications such as pneumonia may develop, which can lead to more serious illness or even death. Those at more risk for complications include the elderly, very young, and people with other chronic illnesses. During the recent H1N1(type A) influenza outbreak, a significant number of deaths occurred in otherwise healthy young persons.

Prevention

1. Frequent hand washing, and avoidance of touching hand to mouth, eyes and nose. Use antiseptic hand wash such as alcohol based wipes.
2. Influenza easily spreads via respiratory droplets from patients who are coughing, so avoidance of close proximity to people who are coughing is prudent. Cover mouth and nose when sneezing or coughing when sick.
3. Consider yearly influenza vaccination. For specific recommendations see CDC guidelines.

Treatment

• Bedrest
• Minimize contact with others
• Rehydrate
• Use over-the counter medications as directed for symptom relief
• See your doctor within 48 hours of the onset of symptoms if possible, since antiviral medication may be of benefit if started within the first two days.
• Antibacterial treatment may be recommended for certain cases, since bacterial pneumonia is a common complication of influenza.

House calls & Influenza

For patients with influenza symptoms, a physician house call is always a welcome service. Patient’s with influenza should ideally remain at rest, and should not expose other patients to this highly contagious illness. Patients with shortness of breath or severe symptoms should call 9-1-1 or go to their nearest hospital emergency department immediately.

The Housecall Advantage

• Highly convenient
• No travel required
• No public waiting rooms
• No trip to the pharmacy required
• No exposure to other sick patients
• Minimize exposure to hospital “superbugs”
• Housecall doctors tend to be unhurried
• Easy 24 hour telephone access for followup questions and advice

The Housecall Request

When a patient inquires about our service for wound repair or care, the physician will ask questions to learn the nature and severity of the wound, and whether tetanus vaccination is needed. Once the doctor determines that a housecall would be appropriate, and if the patient then agrees to the service, a physician will respond with a given estimated arrival time. The patient remains in the comfort of their own home or hotel room.

The Housecall

Upon arrival, the care provider will examine the patient, then offer treatment options, which may include suturing (stitches), adhesive or staple placement. Tetanus prophylaxis may be given if appropriate. A sterile field will be setup, usually involving sterile drapes placed around the injured area. Our patient’s comfort is top priority and we will always take the time to ensure adequate anesthetic pain relief prior to performing any procedures. The wound will then be cleansed, repaired and bandaged. Occasionally antibiotics or other medication may be dispensed or prescribed. Paperwork, including a form for insurance reimbursement will be completed. Detailed instructions will be given to the patient regarding followup care.

Followup Care

Patients may call us anytime 24/7 should they have questions or if problems arise. Sutures or staples may be removed by our doctor or any qualified medical provider. For certain injuries, specialty surgical followup may be arranged by us or by your primary doctor.