How to choose an in-home doctor

You have decided already: the trips to the waiting room are not working any more, and you want the doctor to come to the house instead. Now you have three phone numbers on a notepad, and every website says the same warm thing. Compassionate care. Where you are most comfortable. Serving New Jersey families.

None of that tells you how the practices differ, and they do differ. What separates them shows up in the answers to about a dozen plain questions.

The questions to ask before you commit

Ask these on the first call. A practice that does this work properly will not be annoyed by any of them.

1. Who actually comes to the house: a physician, a nurse practitioner or a physician assistant?

Any of these can deliver excellent in-home medical care, and advanced practice clinicians manage complex older patients every day. The point is not to insist on one or the other. The point is to know.

A good answer names the role, says which physician supervises or collaborates, and tells you whether you will see the same person each time. A poor answer is a vague "one of our providers" and nothing more.

2. Do you take my insurance, and is there any fee beyond what insurance covers?

Ask it in exactly that two-part form, because the second half is where surprises live. Some practices bill insurance and that is the whole arrangement. Others add a concierge, membership or annual retainer fee on top, sometimes several thousand dollars a year.

A membership model is not dishonest, and some families are glad to pay for it. What is not acceptable is being told "we take Medicare" and discovering the retainer in the sign-up paperwork. Ask about your likely copay, any annual fee, and whether phone calls are billed separately. Our guide on whether Medicare covers house calls explains how the billing normally works.

3. How long is a visit?

This reveals the most about how a practice is run. At-home doctor visits are worth having partly because they are unhurried, and a first visit that is really a full history, exam and medication review takes most of an hour. If the answer is fifteen minutes, you are being offered the clinic experience with a longer drive attached. If the answer is "as long as it takes", press gently for a typical number.

4. How quickly can someone come out for a new patient, and for an urgent problem for an existing patient?

Two separate numbers, and they are not the same. A new-patient wait of one to three weeks is normal. The second number matters more: when your mother has a fever and a cough on a Tuesday morning, can someone be there that day or the next?

People choose visiting doctors in NJ largely to avoid unnecessary emergency room trips, and a practice with no same-day capacity for its own patients cannot deliver that.

5. Who answers the phone after hours, and what happens at 2am?

Ask who picks up: an answering service that takes a message, or a clinician on call. A good answer is specific, with a clinician on call, calls returned within a stated time, and a plan for the middle of the night. A poor answer is "leave a message and we will get back to you in the morning" with nothing further. That is a practice that will send you to the emergency room by default.

6. Can you draw blood, do an EKG and arrange imaging at home?

An in home doctor for elderly patients who cannot easily travel is only half a solution if every test still means an outing. Ask whether blood is drawn during the visit, whether the clinician carries an EKG, and how mobile X-ray or ultrasound is arranged. Nobody brings a CT scanner to the house, so some tests will always mean a trip. The question is how much happens at the kitchen table.

7. Will you coordinate with my existing specialists, and do you send them notes?

Most older adults with several conditions already have specialists they trust and do not want to lose. A house call practice should slot into that picture, not compete with it. Ask whether visit notes are sent to those specialists, and whether the practice will call them directly when something needs discussing. Reluctance here is a real red flag.

8. Do you visit assisted living and independent living residences?

Plenty of practices see patients in private homes only. Others visit assisted living, independent living and family homes alike. If your relative lives in a residence, or may move to one within the year, ask now rather than changing practices later.

9. Do I have to be homebound?

The correct answer is no. For a physician house call there is no homebound requirement. The homebound rule people have heard about belongs to Medicare home health, a different benefit involving visiting nurses and therapists. Our guide comparing home health, home care and house calls sets out the distinction.

If a practice tells you your parent must be homebound to be seen by a doctor at home, they have confused two things, and that is worth noticing.

10. What happens if my relative needs a hospital?

House calls are not emergency care and no practice should claim otherwise. Ask when they would advise calling 911, whether they help judge if a hospital trip is truly necessary, and whether someone visits soon after a discharge.

11. How do results get communicated, and to whom?

Ask who calls with lab results, how long it takes, and what happens when a result is abnormal. Then ask the part families forget: can results be shared with you as well as with the patient, and what does the practice need in writing to allow that?

12. Can a family member join the visit or be on the phone?

For a daughter in California or a son who handles the medications, this is not a small detail. A good practice treats a family member on speakerphone as normal and useful. If joining is discouraged, ask why.

Checking credentials

You can verify a lot in ten minutes. New Jersey licences can be looked up through the state Division of Consumer Affairs licence verification service, which confirms that a clinician is licensed and in good standing. Board certification can be checked with the relevant certifying board, and for primary care you are looking for internal medicine, family medicine or geriatrics.

Ask for the name of the clinician who will be visiting before the first appointment. A practice that will not tell you who is coming to the house is the one genuine deal-breaker on this page.

Red flags

• Pressure to sign up during the first call. This is a long-term relationship. Nobody credible needs a decision today.
• Vagueness about fees. If you cannot get a straight answer about membership or retainer costs, assume the answer is one you will not like.
• No clear after-hours arrangement. Ask twice. If it stays fuzzy, it is fuzzy.
• Unwillingness to talk to existing doctors. A practice that wants to be the only voice in a complicated patient's care is solving its own problem, not yours.
• Guarantees that sound too good. No house call service can promise you will never see a hospital again.

Preparing for the first call

Have four things written down before you dial, and the call takes ten minutes instead of thirty:

• The medication list, or the bottles lined up in front of you.
• The insurance card, including plan name and member number.
• The current doctors, with specialties and practice names where you know them.
• The main concern in one sentence. "She has fallen twice since March", or "he came home from the hospital last week and nobody has seen him since."

It also helps to know what the first appointment involves, which our guide on what to expect at a first home visit covers in detail.

If you would like to ask us these questions

Life Primary Care is the at-home primary care service of Life Medical, and we see patients in Somerset, Morris, Union, Essex, Passaic and Bergen counties. We are glad to answer every question on this page on the phone, including the awkward ones about fees, with no expectation that you sign up.

If a different house call doctor in New Jersey turns out to be the better fit for your family, that is a good outcome too. To talk it through, call 973-607-4911.