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Revisiting the House Call

This model of care is an option clinicians should reconsider

While obtaining my education, my peers would often question my interest in home care and house calls. They envisioned me mounting my trusty stallion in the middle of the night, facing a fierce snowstorm, arriving just in time to save a life, and then being paid in baked goods or the random frozen bird.

Years later, there is some truth in this and I would encourage all primary care providers to consider such services.  Here is why:


  • No longer does the parent have to pack up the ill child, as well as, the other 3 kids to drive to the clinic and wait in the lobby
  • No longer does an adult child have to take vacation time to bring his confused mother in the rain to an appointment or just to have labs drawn
  • No more germy waiting room


  • Transportation concerns
  • Decrease the "white coat syndrome" and anxiety


  • Why does that child's asthma keep flaring? In the clinic, you would not know the home has a 30-year-old carpet, has not been dusted in 10 years, and they live next to a farm, which sprays often.
  • Why can't you get the HGA1C below 10? You hear of a perfect low carb diet, but the home tells a different story with a buffet of carbs next to their recliner and on the counter tops.
  • Why does this wound not heal? You hear of proper dressing changes but in the home, you realize they have no running water, they are reusing gloves to cut costs, and they, actually, live alone, which prevents the dressing from being changed twice daily.


  • Increase reimbursement for time and mileage
  • Increase in trust and connection to the patient
  • Occasional bonus of frozen chickens, cooked meals, seasonal pies and crocheted dolls clothes

Just as house calls have an array of advantages there are some disadvantages that could deter a clinician from choosing to participate in this model of care, including travel time between locations and the burden of transporting equipment and supplies. Safety concerns can also be cause for hesitation. While I have never experienced a situation where I have felt unsafe, I understand the concern. Providers can take various precautions to protect themselves and their practice.  

The house call is not for all providers, but for the healthcare professionals looking for variety and adventure this is a viable option. Additionally, for entrepreneurs seeking a start-up, this is a great way to keep cost to a minimum, while providing compassionate care.

Rachael Cabral Guevara is the owner of NPHS - Nurse Practitioner Health Services LLC.

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Sounds very interesing. I would like more information on how to get started, what business model did you follow, etc...

Shedrick  Shields December 11, 2016

I (NPHS) provide direct access/pay services. I do not submit to insurance for reimbursement. You are correct, they would have to be homebound to submit to insurance. There are companies out there that do submit though and are reimbursed.

Rachael Cabral Guevara,  FNP,  NPHSJuly 09, 2016
Appleton, WI

Sounds great and interesting, but I thought the patient had to be "homebound" for insurance to reimburse. Or do you charge cash only? Thank you.

Patrick AusbandJuly 07, 2016


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