Mobile Apps Make Nurse House Calls Cost-Effective

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Receiving health care without leaving home has become viable in rural America thanks to telemedicine.

Now, receiving health care without leaving home is becoming increasingly common in urban America, thanks to nurses who make house calls on demand.

The same trend has produced some uptick in physicians making house calls, too, but it is nurses who are driving the trend. In fact, they’re literally driving it, by combining nursing delivery with Uber driving.

Mobile apps and home health nursing

Uber isn’t merely observing this trend. The company, the proprietor of a mobile app that customers use via their smart phones to solicit transportation from Uber-connected freelance drivers,  is moving swiftly to employ a million people worldwide and to make nurse practitioners one of its largest driver categories.

The Uber/health care tie-in is no accident. Much of it was the conception of Oscar Salazar, a founder of the pioneering New York doctors-on-demand enterprise Pager who previously had been an executive at Uber.

In 2015, a pioneering Chicago nurses-on-demand enterprise Go2Nurse has expanded upon the concept.

Go2Nurse has been operating in the Chicago and Milwaukee metro areas since September 2014. It originally was designed to utilize smart phones in an on-demand operation for nurses, but it quickly began evolving.

Several independent nurses signed up and, after background checks, soon more than 200 registered nurses were free to offer their services, choosing their own times of availability.

Soon Go2Nurse began to focus on case-management functions — which generate $6 billion in annual revenue, according to market researcher IBISWorld — such as follow-up and education, which were sanctioned by insurance companies so that nurses seldom collect payments directly from patients.

“Nurses have long been at the center of care logistics and implementation,” wrote Go2Nurse CEO Meg J. P. Kubiak on the company’s website. “Acting as patient advocates while physicians have made the important decisions. What we are doing with Go2Nurse is placing care coordination, and all of its logistics, entirely in the hands of patients and their nurses.”

The company’s pilot program began with a base of 1,000 potential patients, and by the end of 2015, Go2Nurse was expecting that number to expand to 25,000.  The clientele has included not only patients provided by partnering health care organizations but also many individuals, whose base fee is $37.50 per hour. Some pay out of pocket, but many are covered by insurance, Medicaid and Medicare, said Edward Ben-Alec, one of Kubiak’s co-founders.

“…someone with a sore throat or minor laceration can just as easily be treated in the comfort of their own home, so why disrupt their entire day or pull them out in the cold when you can go to their bedside? It’s a better model.” – Kim Henderson, physician with Pager

Then came the Uber angle, with the major milestone being a flu shot delivery program in a one-day trial on October 24, 2014, in several Eastern U.S. cities, and then greater consideration of what sort of people needed nurses on demand the most.

One of the recent trends is more people requesting rides via Uber to transport aging parents to doctor’s appointments. Uber reportedly may expand transportation services specifically to assist this population in some markets.

Nurses-on-demand have become part of the campaign to reduce the use of emergency rooms as a primary source of care for the indigent and the uninsured. “There are definitely certain patients that belong in the hospital emergency room,” said physician Kim Henderson, who was an emergency medicine physician for 12 years, and now works full time in New York for Pager, in an interview with the National Public Radio affiliate KQED.

“But someone with a sore throat or minor laceration can just as easily be treated in the comfort of their own home,” Henderson said. “So why disrupt their entire day or pull them out in the cold when you can go to their bedside? It’s a better model.”

Pager charges $50 for a doctor’s visit. It had 20 doctors and 15 nurses as of KQED’s June 29 report, which also noted that Heal, which began in Los Angeles and expanded to San Francisco, charges a flat fee of $99 for consultations of 20 to 60 minutes.

Telemedicine vs. nursing-on-demand

It’s understood that nurses (and doctors) on demand are no substitute for a personal physician and are not in direct competition with telemedicine.

“The benefit of telemedicine at the patient level and national level is a tenfold increase in operational efficiency,” Pat Basu of Doctor on Demand, a major provider of telemedicine-oriented physicians, told KQED. “House calls — even if it is the best example of in-patient care — does not have the same magnitude of efficiency. . . In telemedicine, with some common ailments like urinary tract infections and pink eye, meeting the doctor (in person) is not really necessary.”

Go2Nurse’s Kubiak says there’s no argument about that.  “There is no substitute for licensed medical doctors,” Kubiak wrote, “but their time is becoming more and more constrained and wasted these days on ‘paperwork,’ electronic and actual paper that does nothing to cure patient ills.”

Although the concept is all about flexibility for patients, it also means flexibility for nurses, Ben-Alec, stresses, pointing out that “2.5 million nurses are licensed and don’t practice their profession,” and that many “get burned out by the demands of working in a hospital or opt to leave the field to care for their children.”

With Go2Nurse, “nurses have the ability to control their work environment much better. They can do work from home. They can go out into the community and help patients. All without having to deal with an HR person at a hospital.”

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