Could Home Care Podiatry Be An Appealing Option In Uncertain Times?

As we enter our second year of the COVID-19 pandemic, we have learned to navigate through shutdowns and restrictions to keep our practices and way of living alive. We have also seen the sudden shift in our economy to at-home services, including Amazon, Grub Hub and Instacart which have become household names in this “new normal.” Home medical care services also flourished during the shutdown and gained a lot of traction during the pandemic. Agile health care providers also pivoted in an attempt to cut costs and increase revenue by mobilizing their practice.

A 2021 news piece from the University of Virginia Health System highlighted a research article chronicling the surging demand for in-home care services for an aging population who are more than willing to age in-place with large cohorts isolated at home and having limited ability to leave.¹ This provided a unique opportunity for multiple health professionals to shift their practice and grow market share by developing a home care provider practice.  As a podiatrist, this is a perfect opportunity to become a “gig” employee by working part-time with a group as an independent contractor or to re-connect with patients unable to come to the office during the pandemic. As a recent graduate, mobile home care may provide a low-cost start-up option with an immediate  revenue-generating source of patients and referrals, as other health care professionals in the mobile community welcome specialty services in the home, especially podiatry.  Let us take look at what it takes, from my perspective to get started, along with the pros and cons of a home-based practice.

Most likely, we all have experience with home care podiatry in some form or another. Whatever the case, this has always been a tool to start or expand your practice or shift to a growing segment in the economy in this area. As a seasoned provider, I’ve experienced the highs and lows of running a practice. In March 2021, I had the opportunity to work as independent contracture in Las Vegas for Toe-tal Family Footcare Associates, a home care podiatry practice based in San Diego and Las Vegas under the leadership of Mark Miller, DPM. One unique aspect of this opportunity is that I commute from Long Beach, CA, to Las Vegas on a weekly basis to provide services burgeoning growth market particularly in specialty services in the home.   

A typical week begins on Tuesday morning as I board a short 45-minute flight from LGB to LAS on Southwest Airlines where I‘ve accrued enough flights to be a preferred customer, allowing me to board first and sit in seats that normally would be first-class on any other carrier. Once I gather my luggage, I start directly from the airport seeing 8-to-10 patients a day for three days before heading back to LGB for the weekend.  It surprisingly does wonders for the marriage as well.  In my observation, breaking into the marketplace is not as hard as you might think with nursing facilities, rehab centers, assisted living, board and care homes are a key referrals to get your feet on the ground. Homebound patients from home health and hospice agencies who often certifies their status are excellent for a podiatrist and compliments the agency with an additional specialty service provider.

It is important to note that documentation is paramount for the home care provider, as you must establish eligibility of the patient to be seen at home, in addition to including all relevant information to optimize care and pass any potential audits. Medicare section 30.6.14.1B9 details what codes to use and emphasizes the documentation and medical necessity of a home visit in lieu of an office or outpatient visit.² Not all home health and hospice referrals are home bound patients. I had a patient referred by a hospice agency for a consultation, but who seemed to be unavailable for an appointment. I came to find out on a follow-up call that he goes to the gym at least 4 times a week. This is not an appropriate homebound patient for podiatry or hospice. One must always document a patient’s homebound status in the chart to support that they qualify for services from an insurance perspective.

Now that we’ve established the need and benefit to prospective patients, along with what a typical day looks like, in my next blog, we will take a look at the pros and cons of this type of practice.

Dr. Pacada is a mobile podiatrist practicing in Las Vegas, Nevada.

References

1. University of Virginia Health System News. Growth in home care failing to keep up with surging demand. Published April 15, 2021. Available at:  https:newsroom.uvahealth.com20210415growth-in-home-care-failing-to-keep-up-with-demand . Accessed February 1, 2022.

2. Hood GA. OIG regulations for house calls bring challenges for doctors. Medscape Business of Medicine. Published April 10, 2017. Available at: https:www.medscape.comviewarticle878236_2 . Accessed February 1, 2022.