House Calls Make Comeback, Fueled by Technology, Busy Patients

Aug. 30--The old-school house call appears to be making a comeback with a little high-tech help.

Heal, a new startup with a smartphone app that gives patients access to on-demand doctor service, is billing itself as the Uber of house calls.

The service, which recently expanded to San Francisco, allows users to schedule an appointment or search for a nearby physician available within the hour for a visit from the phone app -- similar to ride services like Uber and Lyft.

"It's the old-fashioned way of doing things. We've just amped it up a bit," said Dr. Renee Dua, founder and chief medical officer of Heal, which began in Santa Monica.

Back in the 1930s, in much more rudimentary medical times, about 40 percent of doctor-patient visits were house calls, according to a medical journal article. By 1980, house calls made up less than 1 percent of routine doctor-patient interactions.

But in today's busy world, patients now want the convenience of having the doctor come to them, Dua said. Typical patients include hardworking professionals and parents, and seniors who may find it difficult to make it to a doctor's office, she said. Physicians, in turn, like that house calls give them an opportunity to spend time with their patients at their own pace without a strict timer.

Customer service

Dr. Justin Davis, a San Francisco physician who until recently had been offering house calls for 10 years through a company called the House Doctor, said it makes sense that house calls are becoming popular again after all these years.

"Whether it's Uber or Amazon or Google, everything is coming back around to where people are getting things delivered," he said. "It's convenient, and it's about customer service."

Also fueling the new trend is that mobile medical gadgets, from heart-monitoring devices to on-the-spot testing kits for strep throat and other conditions, allow doctors to do in the home much of what they normally do in the clinic.

"The doctor's visit, in the conventional sense, is changing," Heal's Dua said.

Smarter solution

Dua, a nephrologist in private practice, said she developed the idea for Heal last year after waiting more than eight hours in an emergency room with her young son for something that could have been treated with less hassle. She figured there had to be a smarter way.

She started Heal in Los Angeles in February and has since expanded the business to San Francisco and Orange County. She has contracted with or hired more than 100 doctors in California, an arrangement that provides another benefit to doctors: They can avoid the hassle of running their own business.

Dua's is not the first or only service offering house calls that has popped up this year around the country. In New York City, a company called Pager will send a doctor to your home within two hours for $50 for the first visit and $200 afterward. Another mobile app, DrNow of Houston, will dispatch in-home care for $199.

Heal doctors are on call from 8 a.m. to 8 p.m., and the service costs a flat fee of $99 per visit, which includes having a medical assistant and doctor come to the home. Additional costs apply to lab tests, prescriptions, imaging and other services.

These on-demand services generally don't accept health insurance, though most provide information for patients to submit their own claims. Dua said she is in talks with major insurers, however, and hopes to negotiate contracts by the end of the year.

Removing overhead

Davis said he's not surprised that more companies are springing up to offer doctor visits in the home. He recently joined a new San Francisco startup called FirstLine, which began offering online or virtual visits last year but flipped its business model in June to focus on in-home visits.

"We were getting a lot of requests from our online clients for in-person visits because there's a limit of what you can do through telemedicine," said Bryan O'Connell, co-founder and chief executive officer of FirstLine, which serves patients throughout the Bay Area.

"What we're really trying to do is disrupt the notion of urgent care and take out all that overhead associated with a physical location," he said.

Heal's executives also say they want to divert care from crowded emergency rooms, which could reduce health costs. The company recently secured $5 million in funding and plans to expand to 12 to 15 new markets around the country within the next year.

Shima Lal, 35, of San Francisco, recently felt a sore throat coming on and thought she might be getting the same bug that had recently afflicted her husband and 2-year-old son. She was worried about infecting her 4-month-old daughter, so she turned to Heal.

Dr. Matthew Walvick showed up promptly at her door with a medical assistant. Turns out Lal likely had a virus and did not require treatment, but the visit gave them to opportunity to discuss some of her health needs and what to do if her symptoms got worse.

"I have two kids now, so it's a hassle just to get to the store," Lal said during the appointment in the living room of her Rincon Hill condominium.

Walvick, a primary care physician who joined Heal last month, said the new venture allows him to practice his preferred type of medicine. "I can spend 15 minutes with you, or I can spend an hour or more if needed," he said.

Keeping very busy

When Walvick isn't out on a call, he sets up shop in a San Francisco cafe to wait to be summoned. But he's spent little time there lately.

On the day he visited the Lal household, Walvick had already been on five other house calls -- one of which required him to send an elderly diabetic woman to the emergency room -- and was heading out to another appointment at 7 p.m.

Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com Twitter: @vcolliver

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