A Risky Housecall

A lady at the Holiday Inn in North Hollywood reported that her husband was suffering diarrhea. She added that he had fainted during the last several episodes. I had never heard that before. Doubting that I could solve the problem, I told her we needed to call the paramedics. Sure enough, they took him to the hospital for a day of rehydration.

Warning! Make Sure You're Admitted!

This is strictly for American readers, but others will get a taste of the grotesqueries of our medical system.

Let’s say you’ve been vomiting for a few days and drag yourself to an emergency room. The doctor says you need IV fluids, so an aide wheels you to a room where you spend the night and most of the next day and then return home, feeling better.

Or you have chest pain. The ER doctor doubts that it’s a heart attack, but he wants to keep you for observation. After two days connected to a heart monitor and getting blood tests, you’re discharged, feeling better.

In both cases you’ll get a bill for at least $5,000, and YOUR HOSPITAL INSURANCE WON’T PAY!! 

Hospital insurance only pays if you’re admitted to the hospital, but remaining in a holding area for a few days or being kept “for observation” is not admission. You’re still an outpatient, so you’d better have good outpatient insurance.

If you’re over 65 and have Medicare Part A (which is free) but have decided to skip Part B (which costs $109 a month) you have no outpatient coverage. Part A only pays for the hospital. If you’re under 65 and have the usual Blue Cross or Blue Shield, you’re largely covered for hospital charges. Depending on the policy you’re willing to pay for, outpatient coverage varies. A lot. 

The solution, when the ER doctor announces that you need to stay for a while, is to ask: “am I admitted or not?”

Of course, you’re probably miserably sick or frightened (if not, maybe you shouldn’t be in an emergency room), so asking about insurance is not a priority. Woe unto you if you don’t.

The End of Narcotics

I once carried narcotics but gave it up. It’s too much hassle.

For garden-variety pain, codeine, Vicodin et al are sometimes but not always superior to over-the-counter pain medicines. I liked them because hotel guests have usually tried ibuprofen, Advil, Motrin, naproxen, etc. During the visit, I can hand over a few days of narcotics, and the guest knows he’s getting something different.

Nowadays, when I determine during the phone call that the guest only needs a pain medicine, I have nothing to offer, so I end up not making the visit. Many guests don’t want to pay the housecall fee in exchange for a prescription.

In an effort to fight the raging opioid epidemic, states have passed laws to keep track of narcotics. Pharmacists now send a report to the state for every narcotic prescription they fill. That’s easy because pharmacists already record everything on their computer, so they merely hit an extra button to send the report. 

If I hand out a few narcotics, I must sit down at my computer when I return home, find the reporting form, and fill it out. Some of the questions seemed cryptic, so I worried that I wasn’t doing it correctly. It seemed safer to stop handing them out.

An Odd Anecdote

Long ago when I was a medical student, a woman came to our gynecology clinic to have an IUD removed.

Five years earlier, when abortions were still illegal, she had had an abortion. For some reason, the woman believed that IUDs were also illegal. The abortionist said that he would insert an IUD for an extra $180, and she agreed.

When the resident looked inside, he didn’t see a string hanging out of her cervix. All IUDs have this string, so they can be easily removed. He ordered an X-ray. It showed a bobby pin.

The resident removed it in the operating room, rusty but intact. It had served her well for five years.

Gratitude is All I Get

The Adventure is a large motel near the airport that caters to foreign tourists on a budget. It’s full of colorful, young Europeans and Asians. The owner-manager phoned to inform me that his girl friend was sick. Could I see her? He would pay.

That was the third time he had asked me to see the girl friend who had a tendency to get sick. I like calls from general managers because it gives me a chance to do public relations.

After my first visit, I waved off his money but suggested that I’d like to be the Adventure’s doctor. He expressed gratitude and promised to tell his employees that I was the man.

Six months later, after the second visit, I refused his money and reminded him of his promise. He expressed gratitude and swore he would give my name to everyone.

Doing favors for general managers has won me new hotels, but it’s remarkable how often it hasn’t. Most of the time, gratitude is all I get. On my third call from the Adventure’s manager, I accepted his money.

Frustration

I drove to care for a woman with a respiratory infection at the Georgian, a boutique beach hotel in Santa Monica. My phone rang as I pulled up at the entrance. The caller was JI, a Japanese travel insurance agency with a patient in a downtown hotel. Ten o’clock is perfect for driving downtown. Freeway traffic dips until noon when it begins a steady climb toward the evening rush.

“I can be there within the hour,” I said only to hear that the patient wanted someone between 4 and 6. I explained that people don’t realize how quickly I arrive. I could be there in 45 minutes. She checked but informed me that the guest wanted to go on a tour. Disappointed, I agreed to arrive at 4, a very inconvenient hour.

The phone rang soon after I returned home, a lady at the airport Westin whose husband was coughing. Did I accept Blue Cross? I didn’t. American insurance pays skimpily for a housecall, and billing requires skill and patience; foreign insurers do better. I gave directions to a walk-in clinic a mile away. Many Americans decide that paying for a housecall is preferable; she assured me she’d call back if she wanted a visit.

Night of the Concierge Doctors

Hotel doctoring has always been a dog-eat-dog business, but after 2010 another tiresome phenomenon appeared: concierge doctors.

These provide a personal service for a large fee in cash, no insurance -- American insurance -- accepted. Google “concierge practice” for the creepy details. When asked, these doctors insist that they’re not in it for the money which means that they’re in it for the money.

Building an office concierge practice from scratch takes a long time, but hotels are low-hanging fruit. Ambitious concierge doctors visit the general manager, something I never do. Even more effective is telling the staff that every call is worth $50. It’s illegal for a doctor to pay for a referral, and all deny doing this, but bellmen and concierges have begun hinting that, maybe, I’d forgotten something when I walked by on my way out.

I charge $300 to $350 for a housecall. Concierge doctors charge between $600 and $3000…. $3000?! Who pays $3000? The answer is: foreign travel insurers. Everyone in the world knows about America’s rapacious medical system so when an insurance clerk in Spain or Japan gets a bill for $3000, he probably assumes that that’s the going rate. This is no small market; insured foreigners make up a third of a hotel doctor's business.

At the lower end, American hotel guests will usually pay $600 to $1000, although they grumble. There is no free market in hotel doctoring as in all other areas of medicine. If guests want a housecall at a hotel served by a concierge doctor, that’s what they pay.