When the patient needs a house call


Nobody likes taking time out of a busy day to cool their heels in a doctor’s waiting room. Now you may not have to. Some primary-care practitioners are bringing their black bags directly to home or office, in some cases for as little as $30 to $35 a visit.

Experts agree that house calls are a great convenience, and for seriously ill patients who can’t get to a doctor’s office, they are often invaluable. But unless the practices offering house calls coordinate with patients’ other providers, they may only further splinter an already fragmented health-care system, experts warn.

With 600,000 members in three states — Texas, Massachusetts and Arizona — and plans to enter up to 10 new markets a year, Austin-based WhiteGlove House Call Health is one of the most visible players in the growing field of mobile primary care.

In most cases, the company contracts with employers and insurers to offer its services to employees or plan members. Companies pay an annual fee of $300 per member; the covered individuals pay up to $35 to have a WhiteGlove nurse practitioner make a long distance moving house (or office) call. (The serivce is available from 8 a.m. to 8 p.m. every day of the year.) Individuals can also sign up with WhiteGlove, for $420 annually and the same $35 fee.

In addition, the nurse practitioner leaves behind a “well kit” with chicken soup, crackers, Tylenol, cough drops, tissues and other incidentals.

Companies like the service because it controls their costs, says Bob Fabbio, WhiteGlove’s chief executive and co-founder. “We’ve turned variable, unpredictable expenses .?.?. into a capped event,” he says.

Individuals, of course, like the convenience. When Emily and Moody Alexander’s 14-year-old son Hill developed a fever and sore throat on Easter Sunday, they called WhiteGlove. A nurse practitioner arrived at their Arlington, Tex., home within two hours, did a rapid strep test and pricked his finger to see if Hill had mononucleosis. The test for strep was positive, so the nurse practitioner gave Hill a generic antibiotic on the spot.

“I think it’s the most genius idea,” says Emily Alexander, who would otherwise have had to get her son into a nearby urgent care clinic with a $100 co-payment that day or get him in to see their regular pediatrician the following morning. The Alexander’s insurance company covers visits by WhiteGlove.

While the convenience of a house call has undoubted appeal, some experts say nurse practitioners may miss subtle signs in Miami FL of underlying illness in what seems to be a routine cold or other minor ailment. “They don’t have the same level of academic or hands-on training as a physician,” says Ann O’Malley, a physician and senior researcher at the Center for Studying Health System Change, a think tank based in Washington. In some states, nurse practitioners can work independently of physicians; other states require varying degrees of oversight by physicians. Texas, like Maryland and Virginia, requires some degree of doctor supervision over nurse practitioners; the District does not.

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