The Future is Now: Doctors Contradict Business Model to Bring Back House Calls

What if your Retirement Community opened its doors to every employee from every health care company that wanted to get into its building to provide services – Home Health, Hospice, Personal Care, DME, PT/OT, etc.?  It would be over-run with literally hundreds of community employees roaming around everywhere!


Now, for an interesting contrast…

What if your Retirement Community opened its doors to all the local physicians seeking to provide on-site services?

HellOOooooo…Anybody there???


In one case – out of control chaos!  In the second – emptiness, silence…

Why?  Why this difference?

What’s the difference between doctors and all the rest of the community healthcare services that results in such disparity in where their services are performed?  Is it that doctors aren’t interested in providing on-site care in the community whereas everyone else is?  Hardly!  Doctors should be the leaders of a collaborative healthcare approach that includes all these services, so why are they “missing in action?”

The answer to this question is conspicuously absent in our Retirement Community dialogue, and understanding the answer is crucial to reversing this shortcoming.  The answer is the BUSINESS MODEL.  The business model for a doctor’s medical practice is completely opposite the business model of all the other services.

The doctor’s business model is that his practice is located in his office ( This is where he has everything he needs to conduct his business.  You take him out of his office, and he’s helpless…he has none of the support he needs to conduct his medical practice – no exam room, no supplies, no  schedule, no receptionist, no billing clerk, no nurse, no medical assistant, no lab, no EKG, no x-ray.  Consequently, if patients want medical care, they must go to the doctor, or they simply don’t get care.  If you try to break this paradigm and encourage the doctor to go to the patient, the doctor’s medical practice becomes unprofitable because of the inefficiency that results from contradicting his business model.  And since no one can sustain a successful business by being unprofitable, doctors rarely practice outside their offices.

Contrast this with the OPPOSITE business model of nearly all the other healthcare services.  Their place of business is in the patient’s home.  Their business operates on the principle of providing home based care.  They don’t need to equip an office in which to provide their customary care, and so they couldn’t provide office based care even if they wanted to.

But there’s a way to bring doctors and community healthcare services together to work as a team in Retirement Communities.  This requires an innovative healthcare model that offers doctors the ability to contradict their usual paradigm and practice profitably on-site outside of their office (

What if doctors were willing to adapt this new paradigm and reach out to Retirement Communities to provide regularly scheduled on-site full primary care services in the residents’ rooms?  Would this be the kind of valuable service a Retirement Community might consider investing in, assuming their investment was not cost prohibitive?  Or, would Retirement Communities continue with ‘business as usual’ and be unwilling to innovate and achieve what was previously unattainable – offering regularly scheduled on-site physician services to every resident?

Think the same, stay the same. Think differently, and thrive!

Think the same, stay the same.  Epitaph?  Or opportunity?  If you are a Retirement Community who thinks this way, then your competitors are silently thanking you.  That’s because, slowly but surely, they will be assimilating YOUR residents (or perhaps already are!).  Make no mistake about it…while you’re playing it safe and not investing in and promoting new services and amenities that distinguish YOU, your successful competitors are doing just the opposite.

Ask yourself:  what do we offer today that we didn’t offer 3 months ago, 6 months ago, a year ago, that brings real value and meaning to our residents and that truly distinguishes us?  Many Communities won’t have an answer, and their silence is just another nail in their coffin.

But to those of you who do have an answer, have you really promoted these services?  Do the homeowners and others who live and work within a 10 mile radius of your Retirement Community (where 70% of your referrals come from) even know what you offer and the ways you are different from your competitors?  Or is your advertising exactly the same as everyone else in your town?

What would be your response to a prospective resident or baby boomer family who were to ask you:  “What distinguishes YOU from all the other Communities we’re going to tour today?”  Would you have an immediate and enthusiastic response?  Or, would you find yourself mumbling and getting all tongue-tied attempting to escape a VERY uncomfortable, yet very basic and ESSENTIAL question.

A follow-up blog will be coming out soon that will offer a suggestion.  In the meantime, think about the following:


House Calls brings the doctor to Country Time Assisted Living!

Better resident health, reduced family stress, and elimination of transportation expenses for routine visits to the doctor’s office.  These are 3 welcomed and much anticipated benefits Country Time Assisted Living in Star, Idaho will offer their 16 residents and families beginning in May 2013.  Full primary care delivered in the residents’ own rooms.   Even more…team based, physician-led healthcare coordination for all residents.

Only House Calls’ partners, small or large, can differentiate themselves from all their competitors with this truly unique and valuable service.



The Healthcare Paradox of Seniors: Greatest Need but Least Access to Physicians

Our seniors are caught in a healthcare paradox.  They have enormous healthcare challenges, and yet many have the least access to physicians because they have so much trouble getting to them.  By 2030 seniors will represent 20% of our population, and they are the largest subgroup of our citizens.  It would be logical to believe that they would be a major focus of attention of the medical community, but this is not happening.  As a result, our seniors are underserved, overprescribed, and under-represented in healthcare delivery and research.

There are intriguing new developments in electronic access to healthcare, but most seniors don’t or can’t use electronic gizmos and are therefore left behind (

Physician medical practices seem to spring up everywhere, but the physicians themselves maintain their traditional business model and force seniors to either come to them for their care or do without.  Too often our cumbersome medical system causes seniors to delay needed healthcare until it’s too late, resulting in an ER visit or hospitalization.  And when they are discharged from the hospital, seniors are given a ream of paperwork with myriad vague and often conflicting instructions which they are then forced to try to disentangle and assimilate, all while they are still weakened and recovering from their illness.

Seniors have the highest number of chronic medical conditions, are the highest consumers of our healthcare dollars, and yet are at the point in their lives where they are least able to financially contribute to the cost of their healthcare.  And yet approaching senior healthcare in the traditional manner does nothing to reduce their overall healthcare costs.

So, what is the solution?  Well, there is no single solution that will solve this paradox, and looking for a magic bullet that doesn’t exist might explain why there has been such little progress in this arena.  And it blinds us to creative approaches that can be identified that can have real and immediate, tangible benefits.  If we make it our goal to “bite off a little chunk” of this problem rather than the impossible task of conquering the entire monstrosity, and if we get creative, we can make a difference in the lives of our seniors NOW…not a year from now, not 5 or 10 years from now, but NOW!

Here’s an example of a “new” and deceptively simple approach.  A “House Call.”  A simple, old fashioned House Call.  A physician bringing full primary care to the home of a senior.   This opens up a world unseen and unknown by most physicians, because what happens in a patient’s home is often VERY DIFFERENT from what the physician imagines from his remote perspective in the hospital or his office.  And here’s the best part of this approach and where the benefit really lies:  once the physician is in the senior’s home, this allows on-site, realistic physician leadership and management of the senior’s healthcare, where the physician sees things the way they really occur and not just the way he imagines they occur.

There are only a few working models of House Calls across the United States, and among the most successful are those providing care in Retirement Communities (Independent and Assisted Living) which are a popular alternative for many aging seniors.  It is here where physicians can schedule a group of patients to be seen in a ½ day clinic, most closely imitating a ½ day in the doctor’s office.

But this approach needs the partnership and mutual support of both the physician and the Retirement Community.  When this occurs, the benefits of an on-site House Call are just what you’d expect them to be:  more appropriate care directed to the reality an individual patient faces at home, healthcare that is actually provided rather than avoided due to the difficulty or impossibility of accessing a physician, and adjusted expectations of achievable results resulting from a better knowledge of the patient and his preferences.  Applied on a broad scale, the House Call would almost certainly contribute to reducing overall healthcare costs.

We must encourage and foster creative approaches to improving the healthcare of seniors.  Everyone who interacts with seniors is a stakeholder.  So I encourage you to think outside of the traditional healthcare box, think creatively, and then innovate by picking just a small “chunk” of this issue and applying your contribution TODAY!

Why Doctors Don’t Go To Retirement Communities…Unless…

Not one single Retirement Community in Idaho (Independent or Assisted Living) has regularly scheduled on-site doctor services offered to all their residents…not one!  Despite the potential value of these services, not only to the residents but also to the Communities, until now there has been no focused dialogue between doctors and Community administrators to try to bridge this gap.

I’d like to explain, from the doctor’s point of view, why this service does not happen.  I will then point to a solution that works for EVERYONE with the hope that we will all work together in partnership to help the elderly who need us.

The short answer?  Going to Retirement Communities contradicts the doctor’s current business model.  Even though many might desire to extend their practice to include these Communities, they simply can’t because doing so is 180 degrees in opposition to their business model and therefore prevents them from running a profitable medical practice.

Here’s the doctor’s perspective:

  • I can either remain in my office with my entire support staff who has arranged a full afternoon schedule of patients waiting in exam rooms to see me, or
  • I can spend the entire afternoon traveling to a Retirement Community where I have no support staff, have to hunt down my 1 or 2 low reimbursement Medicare patients wandering around the Community somewhere, find some place to examine them, and then somehow arrange follow-up testing and appointments.

Everyone simply accepts that if you need a doctor, you go to the doctor’s office, to a clinic, or to the hospital.  The doctor does NOT come to you.

Here’s the dilemma

Healthcare is changing, and this means that doctors and Retirement Communities must adapt to new ways.  In order to reduce overall healthcare costs, there is an increasing focus on delivering as much healthcare as possible OUT of institutions (e.g. hospitals) and in the Community.

Here’s how doctors must change

You must be more creative and develop a business model that encourages you to come out of your office and provide care in our Communities.  There’s a HUGE need and desire for this, and it must be met.  Especially for the elderly for whom scheduling appointments and arranging transportation is so difficult that they will often avoid essential medical care rather than go through all the hassle.

Here’s how Retirement Communities must change

Your market is extremely competitive, and in order to achieve a profitable census Communities must not only attract residents but maintain their loyalty by offering quality services.  When available, on-site healthcare MUST be included.  You must invest in this service just as you would invest in other valuable services you provide.

Here’s a solution

Doctors and Retirement Communities must come together as partners, not competitors.  They must understand that neither is trying to take advantage of the other.  Rather, both are working together, in partnership and to their mutual benefit, to care for the elderly.

Doctors in Boise, Idaho have ‘stepped up to the plate’ and met this challenge by developing a new business model that makes it possible to provide regularly scheduled services to all residents of a Community while maintaining a profitable medical practice.

But this new model requires that Retirement Communities must also ‘step up to the plate’ and invest in a service that their residents want and that will benefit them and make them more profitable by raising their census.

A partnership that includes Retirement Communities, their residents, and doctors, is one in which EVERYBODY WINS!

House Calls newest partner – Bonaventure Place!

House Calls is proud to announce its newest partner – Bonaventure Place in Boise, Idaho!  A gorgeous, spacious community combining both Independent and Assisted Living with many wonderful amenities.  And now Bonaventure Place is one of the only Retirement Communities in Idaho who brings the doctor to the residents!  Any resident may choose to have some or all of their full primary healthcare services provided in the comfort and convenience of their own apartment!  No additional cost – just additional care and comfort!

Come to Bonaventure Place in Boise!  Take a tour, talk with the House Calls doctor.  We look forward to being your next home!

When Health Fails in Retirement Communities: a 3 Step Program for Proactive Healthcare Intervention

Health related attrition is a major ongoing challenge to the census of any Retirement Community.  A solution to this challenge is a COMMITTED FOCUS on a program of Proactive Healthcare Intervention.  Such a program is not only easy to implement with common sense ideas, it’s free!

Here’s my suggestion for a simple 3 step program that will be effective and easy to explain to employees.

Figure 1

Under Step 1: Create a position called: Director of Proactive Healthcare (DPH).  Enlist the support of every employee:  housekeepers, bookkeepers, secretaries, maintenance personnel, bus drivers, cooks, activity directors, everyone.  Encourage everyone who interacts with residents to actively observe for any signs of health problems and to report any concerns immediately to the DPH.

Under Step 2:  The Inflection Point (shown in Figure 2) occurs as soon as signs of failing health are noted.  When the Inflection Point has been reached, take immediate action!  “Don’t wait, or it’ll be too late!” can be your motto.

Figure 2

Here are some examples of failing health employees may observe and then report to the DPH:

  • Frequent falls
  • Bruising
  • Limping
  • Moving slower than usual
  • Missing meals or residents requesting meals in their room
  • Problems taking medications appropriately
  • Pills noted on the floor or lying around on countertops in resident’s apartment
  • Worsening depression
  • Less socializing
  • Confusion

Residents exhibiting any of these signs should be put on a “watch list” and monitored by the DPH until they are back to baseline.

Under Step 3:  The most reliable way of getting a timely and appropriate response from a physician is NOT by telephone.  When a concern is raised, the DPH should go personally to the office of the resident’s physician and speak with him face-to-face.  Provide a concise, accurate description of the changes observed with the resident, and request an office visit at the first possible opening.

As you can see, these are 3 very simple and yet effective components of a proactive focus on the healthcare of your residents.  Implementing these suggestions is easy, does not require any additional expense, and will benefit everyone.

If you have any further thoughts or suggestions about the role of physicians in Retirement Communities, I urge you to comment on the House Calls blog.

This is an important topic, and I look forward to continuing this discussion and hearing other points of view.