2009 Annual Meeting
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Building a Thriving House Call Practice and Profession: Annual Meeting Boasts Record Breaking Attendance!

by Jessica Quintilian, Assistant Executive Director

The Academy’s Annual Scientific Meeting held on April 29, 2009 at the Hyatt Regency in Chicago, Illinois was a sold-out success. This year’s meeting "Building a Thriving House Call Practice and Profession” drew record-breaking numbers, as members gathered to learn how to grow from an individual practice to a large, flourishing one. New this year, and highly valued by our members, were the five-minute "What I do – why I’m a home care provider” segments interspersed between longer presentations. These candid presentations from our members included some key survival strategies that YOU can use to grow your practice.

1) Implement an EMR.

A key to practice growth for one highly successful member, Dr. Alan Kronhaus, was the implementation of a fully integrated, internet-based practice management system with an excellent EMR and a documentation tool that was created using the graphic programming capabilities built into the system. Technology is essential if you want to build a thriving practice.

2) Know your billing.

Another success strategy mentioned by Dr. Kronhaus is being well-versed in Medicare’s documentation guidelines and coding rules. Educate yourself on how to bill at the appropriate level of service and how to protect your records from auditors to the extent possible. Many questions on the Academy’s list-serv address billing issues, and our wonderful resource Making Home Care Work in a Medical Practice: A Brief Guide to Reimbursement and Regulations is updated annually.

3) Practice effective financial management.

This includes following the principles mentioned in Dr. Gresham Bayne’s presentation "The Roads Not to Travel in Building a House Call Practice.” Dr. Bayne mentions that "one of the ten dumbest things he ever did” was to buy an expensive car. He cautions members to carefully consider issues that can derail their practices such as physician salaries, limiting their practice to a black bag, hiring W-2 employees versus contractors, retail advertising, hiring drivers and making decisions based on idealism. (In other words, if Medicare does not pay for a service, don’t do it!)

4) Use the right technology.

Why do house call practices need technology? Dr. Edward Ratner explained in his "Practical Technology for the House Call Practitioner” presentation that house call medicine requires technology for both clinical quality and efficient operation. What a house call replaces drives technology. The WPS Local Carrier Decision for house calls states that "the service must be of equal quality, as if it were performed in the office.” Technology minimizes the need for patients to leave home, minimizes turnaround time for orders and referrals, meets Medicare standards, minimizes HIPAA and compliance risks and can generate income for the practice. What technology is required to provide quality care at patient residences? Dr. Ratner divided the answer into two categories: basic primary care office diagnostic technology and basic medical office administrative technology. Diagnostic technology includes sphygmomanometer, thermometer, otoscope/ophthalmoscope, oximeter, ECG and phlebotomy. Administrative technology includes and electronic patient database, fax, copier, phone and computer/internet access. Dr. Ratner estimates that a start-up solo practice needs $3,000-$10,000 in technology investment.

Other keys to growing a practice mentioned by our speakers included marketing, which can be as important as your investments in technology. Do not forget to get the word out so that people know your practice is an option. The Academy receives daily calls from families looking for house call providers. If you are not listed in our referral directory, ask for a copy of our ethic statement. (Listing requires annual signing of our Principles of Ethics). Dr. Eric DeJonge mentioned in his "Top Ten Clinical Pearls” presentation that much of their success comes from listening to patients and families, and trusting nurse practitioner, nursing and social work staff.

Many of you have benefited from our popular booklet Making House Calls a Part of Your Practice and the steps to starting a practice, which help to define the scope and focus of your practice. The Academy has recognized that a definite need exists to help our members "get to the next level” in growing their practices. We are developing a long-awaited new booklet focusing on practice management to serve as a resource to members who are looking to grow their practices. Watch for details later this summer on when the booklet will be made available.

Annual Meeting

President-Elect Thomas Edes, MD, filling in for Joe Ramsdell, began the lunch time Annual Meeting by thanking our sponsors: Barton Medical Corporation (lunch sponsor and exhibitor), Abbott Point of Care, Lockton Affinity, Mobilex USA and TIMS, Inc. Dr. Edes highlighted some of the Academy’s accomplishments for the year, including the pending reintroduction of IAH, achievement of ONCHIT National Strategy 1.3.9 and the recommendation of Dr. Gresham Bayne to the HIT Standards Committee and Jim Pyles to the ONCHIT federal policy committee, efforts to fight exclusion of house call providers in e-prescribing and HIT, addition of codes to the denominators of PQRI measures, efforts to oppose CMS payment reductions in certification/recertification and care plan oversight, audit updates and new resources available to our members. Dr. Edes announced the new Academy endorsed medical malpractice insurance program offered through Lockton Risk Services. For more information on the program. He then updated members on efforts to come in these areas, as well as new efforts including a home-based research network, improvements to our home care exam and new resources for medical directors.

Board member and chair of the awards committee Dr. Thomas Cornwell presented this year’s prestigious Eric Baron House Call Doctor of the Year Award to Theresa Soriano, MD of the Mount Sinai School of Medicine Visiting Doctors Program. Dr. Soriano joined the respected Mount Sinai Visiting Doctors Program in 2004. Colleagues say, "From the outset, it was clear she embodied fresh perspectives, academic rigor and an untainted idealism in the care of vulnerable populations. She showed an enthusiasm for her work that was infectious.” After two years, she assumed the role of Program Director. Under her leadership, there was an expansion of research with publications in peer-reviewed journals, augmentation of social work, increase in palliative care training, an increase in resident and medical student teaching, development of a nurse practitioner hospital-liaison model to improve care of homebound patients in the hospital and effective and efficient transition back to home, and an enhancement in philanthropic and foundation support.

Dr. Soriano is a strong advocate for house call medicine and an outstanding, caring clinician. A letter of support for her nomination from the New York State Office for the Aging praised Dr. Soriano for her advocacy work and for helping to develop medical training curriculum and evaluation methodology for home visit programs. Despite extensive administrative responsibilities, she is persistently in the trenches, delivering much of her care to the homebound in East Harlem and Washington Heights in some of the most impoverished and dilapidated locations in New York City. In 2007, she was given the Mount Sinai Visiting Doctors Program Resident Teaching Award.

At the AGS Presidential Poster Session, Thomas V. Caprio, MD received the Poster of the Year award for his poster on "Home-Based Screening of Rural Community Dwelling Older Adults by Emergency Medical Services and Referral to Transitional Case Management." Congratulations to Dr. Caprio and his entire project team!

One member’s comment aptly summarized this year’s meeting: "If you missed this year’s meeting, you missed out on a sentinel event for home care medicine.”