Q: Will you spend as much time as the patient and family need?
A: Yes, once I accept a patient, I’m usually available for as much time as is needed. Unlike most doctors, I don’t charge per visit, I only charge based on time spent helping someone, whether that time is in person, by phone, or by email — and whether I’m needed for just a five-minute call or a two-hour visit. This allows patients and families to decide how much time they need with me, and allows me to be flexible and as available as is necessary in a given situation.
Q: Can you become a person’s primary care doctor?
A: Generally no. Instead, I will work closely with a person’s existing primary care provider (PCP) to ensure that my patients get comprehensive and coordinated care. A consultative practice allows me to focus on doing what I do best, which is to address geriatric issues and help coordinate care with other providers.
Q: Do you do housecalls?
A: Yes, all in-person visits take place in the home or assisted living facility. Visits can also be arranged in nursing homes or even hospitals. For established patients, I also have phone, email, and video visits available for follow-up, which is often more convenient and affordable for patients and families.
Q: Do you prescribe medications?
A: Yes, as an experienced internist, I’m comfortable prescribing for most geriatric and general adult medicine conditions, including pain medication when appropriate. In general, before prescribing I will establish contact with the patient’s primary care provider and confirm that there are no objections to my prescribing. I will also always inform PCPs and other involved doctors when I prescribe.
Q: Are you available 24/7 or on short notice, for urgent problems?
A: No, my consultative practice is not set up to provide access or care coverage outside of regular business hours. For after-hours care or urgent care, patients will need to contact their PCP or usual source of medical care. During business hours, I will respond to phone calls within two hours, but cannot provide a same-day housecall.
Q: Do you have an office where patients can be seen?
A: Not at this time. This allows me to maintain low overhead, which helps keep my fees affordable. Also, in my experience, most older patients who really need a geriatrician prefer housecalls.
Q: Do you accept Medicare or other insurance?
A: No, I do not accept any insurance. My practice is a direct-pay practice, meaning that patients pay me directly for my services. This allows me to minimize overhead, keep my fees affordable, and focus my energies on helping older patients. I can, however, order tests and other services that are covered by Medicare. Many patients with supplemental PPO insurance can get reimbursed for my services.
Q: You’re a geriatrician. Why don’t you accept Medicare?
At a policy level, I support the Medicare program and believe it should be strengthened and improved.
However, fee-for-service Medicare currently makes it very hard to sustain a practice if a doctor chooses to only see geriatric patients.
This is because Medicare pays a relatively low fee for every in-person visit, but does not pay for a doctor to spend time on the phone following up with the patient, explaining things to family members, or coordinating a complicated medical situation with other doctors. These are all important facets of geriatric care.
To make ends meet when accepting Medicare, doctors usually have to see 15-20 patients per full day. This is hard to do if all the patients are older and have multiple medical problems, and is especially difficult if the doctor is mostly doing housecalls. This is also why doctors are often in a rush to get off the phone; phone time is usually not paid, and takes away from their more lucrative visit time.
My view of optimal care is different: I believe that encouraging patients to check-in by phone and coordinating care are essential parts of good geriatric medicine. By charging a reasonable hourly rate for my time, whether it’s in person, by phone, or by secure messaging, I’m able to offer excellent support and availability to my patients and their families.
I do hope to resume accepting Medicare eventually, and look forward to doing so once the program’s reimbursement structure begins to support geriatricians who focus on geriatrics, rather than penalizing them for doing so.