Visiting Physician Services is an unusual medical practice: The staff only makes house calls.
But if you think that makes the company a blast from the past, think again: Chief Operating Officer Alex Binder feels they represent the future.
One of the goals of the Affordable Care Act is to control costs by limiting repeat hospital admissions and excessive services. Because of this, some experts predict that, eventually, Medicare and commercial health insurers will pay health care systems a predetermined or “capitated” sum of money to cover all the care a patient needs, regardless of the setting, from hospitals and doctor's offices to home and hospice.
When hospitals are no longer compensated simply for doing more tests and procedures, Binder believes home-care companies such as VPS will play a larger role.
“We know we provide tremendous value, and as the payment model changes, hopefully our value will increase,” he said.
“(If a hospital system is getting a capitated payment for) an elderly patient with multiple chronic conditions that probably has had two or three hospital admissions in the past year, they will say, 'You know what, we would really all benefit if the patient stayed home and was seen in the home by a visiting physician,' ” Binder added. “We would be able to coordinate whatever services they need and be able to keep the cost down. We can improve the outcome because we are working with the family and the caregivers in the home.”
Binder said that type of patient has tripled to 3,000 over the past decade in the eight main New Jersey counties it serves from its Eatontown office.
Visiting Physicians offers an alternative to traditional hospital-based medicine, providing medical care to homebound patients in the last several years of life and generally referring the terminally ill patients to hospice in the last six months, while continuing to make visits and monitor the patient's condition.
“We have the luxury of having a discussion with the patient and the family and let them know what the benefits of some procedures are and whether there are reasons not to do certain things,” he said.
VPS was founded in 1994 by Dr. Jon Salisbury, a leading authority on the home care of the aged, and is seeing steady growth as the medical community gradually moves toward an end-of-life care model that maximizes quality of life rather than quantity of medical procedures.
It has a staff of 31 clinicians: six doctors, 21 advanced practice nurses and four physician assistants.
Binder said two types of doctors are drawn to the practice: “Those who are just starting out and want to make an impact on peoples' lives and see the results of their skills, and physicians who are close to retirement and are tired of the system and just want to practice medicine and be in alignment with the patient and the family.”
Like other medical practices, VPS is paid by Medicare.
Binder, however, estimated that the practice has saved Medicare millions of dollars.
“We avoid hospitalizations and we avoid unnecessary tests,” he said.
If a patient and his or her family members decide they want traditional hospital interventions such as a feeding tube at the end of life, VPS will advise them to seek that care at a hospital.
But Binder says those patients are the exception.
“The majority of the patients who come to us have already exhausted their patience with the traditional system,” he said. “They tell us, 'I just don't want to go through that again.' ”
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