Doctor and Nurse "At Your Door"

Nurses Entrepreneurs

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Interesting Article on Switching Gears on the Dr. Homefront. Why can we not do something like this? Come on Entrepreneurs! Let's hear some feedback:

http://www.cbsnews.com/stories/2002/11/22/eveningnews/main530550.shtml

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Boutique Docs Set Up Shops

Ocean Springs, Miss., Nov. 22, 2002

In Knoxville, Tennessee, Dr. Bryan Smith and registered nurse Pam Williams are trying to practice modern medicine -- the old fashioned way.

Together they are "Doctor at Your Door" -- one of a growing number of boutique medical practices. For an annual fee of $1,100 Smith and Williams will treat you in your home, reports CBS News Correspondent Elizabeth Kaledin.

They make office calls; they're available 24-7. And there's no voice mail. They forward their landlines to their cell phones when they're out on a call. And they carry a back-up phone in case the first one dies.

They have no staff, minimal overhead, and most important, they don't accept Medicare -- or insurance.

"I felt like the insurance companies were practicing medicine," Smith explained.

Before starting "Doctor at your Door," Smith was ready to quit medicine altogether. He said he was going broke.

"I would end up hiring two or three people in the back just to work the insurance. And then we would only get back 40 percent of what we billed."

Doctors across the country are experiencing the same frustrations as Bryan Smith.

"Physicians will be paid in 2005 less than they made in 1991," said Dr. Donald Palmisano, of the American Medical Association.

That -- along with a 40 percent increase in overhead means many doctors are looking for a new job.

"We have a crisis throughout the nation. Twelve states are in crisis right now," Palmisano said.

One of those states is Mississippi, where escalating costs and falling reimbursements mean more and more doctors are abandoning the state -- and their practices altogether.

Determined not to hang up his stethoscope, Dr. Todd Coulter is trying an experiment of his own. At his small family practice in Ocean Springs, he has also sworn off insurance and charges $40 dollars cash per visit.

"When we stopped taking insurance our overhead dropped immediately by $2,800 a month. Just dropped," he told Kaledin.

Rejecting that third party has allowed Coulter to limit expenses while increasing the quantity and quality of time he gets to spend with his patients.

"I'm not under a time table. It's not like I'm working for Kaiser Permanent and I've got to see 50 people by lunch time," he said.

There are no forms to fill out, no waiting for basic care. The patient is happy. And the doctor is staying in business carving out a nice living.

© MMII, CBS Worldwide Inc. All Rights Reserved.

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B.;)

I didn't know this couls be done. What about the legalities?

Most of the "legalities" result from taking Medicare/Medicaid money and from contractual requirements of insurance companies. Other than that the provider has a duty to abide by the professional standards of care, policed by the BoME, and the business and tax laws.

Specializes in psych, medical, drug rehab.

Hello,

Very interesting thread. However what I am confused about is the issue of R.N.'s practicing medicine without a license. I mean, can we do this? I have done community nursing in the past and I am aware that medicare will no longer cover many services. But can i basically set up shop without working under a Physician and market myself , go into peoples homes, draw up insulin, do wound care, give baths, set up medications etc Please forgive me I am not sure that I understand how this can be done. Can anyone give any insight?

Thank you very much in advance.It sounds like not only a great idea for us nurses but lovely for the patients as well!

Mary Jo:)

Hi all

This thread has really gotten me excited...Are there any nurses living in NYC that are seriously thinking of doing this kind of service?

I would love to be an independant homecare nurse...it sound like the best biz opp for nurses available now....

Is there any training guides that can teach us how to do this?

Specializes in Vents, Telemetry, Home Care, Home infusion.
Now couldn't WE, as Nurses, come up with Nurse Services? Anyone doing this?

One example: Primary Homecare Housecall Practice

Specializes in Family NP, OB Nursing.

In my small community, we have a doc who does not take insurance or medicaid/care. He quit several years ago and staffs his office with 1 part time secretary and his wife, an RN. Not only did he not lose any customers, but he has gained quite a following. He also will do house calls.

He has full privileges at our hospital. Your insurance pays the hospital, and you receive a bill from him for his services. Once you pay him, you can submit a reimbursment form to your insurance and they will reimburse you for those services.

We also have several NPs who set up an "After Hours Family Practice"...sort of an urgent care. They charge $25/ visit, which is less than my insurance co-pay, and from what I know they are doing quite well.

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