As a Practical Matter…
Following are some of the most frequently asked questions Dr. Spears encounters, with helpful answers and suggestions. If your specific question is not covered on this page you are encouraged to contact Dr. Spears directly via the Contact Page.
How much do home medical visits cost?
Amounts vary from state to state, but an initial visit - which reviews the patient’s entire medical history as well as current problems - typically takes about 75 minutes. Medicare allowable rates for a first visit vary slightly from state to state, but are on the order of $220-$240. Medicare covers 80% of this cost after the annual deductible has been paid by the patient. At the time of this writing, the annual deductible is $147. The patient is responsible for 20%. Secondary insurance usually covers the patient portion. Payment or proof of insurance is due at the time of the visit. People who have no secondary insurance are asked for the 20% payment after the visit. Medicaid is accepted as secondary insurance but not as primary coverage. People who are members of a Medicare Advantage Plan are generally covered at traditional Medicare rates by their plan. Subsequent visits take 30-45 minutes, with Medicare allowable being about $125, subject to the 80/20 split as noted above.
What does it mean to be homebound?
You must be homebound to qualify for Dr. Spears’ practice. The simplest definition of homeboundedness, offered by Medicare, is that due to illness or infirmity, it is a considerable and taxing effort to go to and from a doctor’s office. This definition does not mean that the patient is not allowed to leave the home, only that it is difficult to do so. (For example, some people continue to keep occasional office appointments with specialists.) Lack of available transportation does not make one eligible for homebound status under Medicare guidelines.
How are appointments scheduled?
The first visit usually takes place within one week of the initial telephonic encounter with Dr. Spears. Different geographic areas are covered on different days. We do not offer mobile emergency care; however, after a first visit, many problems (such as URI, UTI) can be addressed between appointments. At times, a visit must be made prior to the next scheduled appointment. Subsequent appointments are scheduled, on average, every 6 weeks. In order to maintain continuity and relationship, experience has shown that visits need to take place at a minimum of every two months.
May the patient continue to see their primary care physician in the office?
We understand than it can be difficult to conclude a long standing relationship with the doctor, because of homeboundedness. However, it is not in the patient’s best interest to have two primary care physicians simultaneously. If you like our services after a first visit, it is probably a good idea to conclude the prior relationship.
What about the hospital, Urgent Care Center and the Emergency Room?
Before the availability of medical home visits, primary, episodic care was provided in these settings. In our experience, many people tend to use these facilities less and less after a trusting relationship has become established with the primary home care practitioner. In the face of acute developments, however, it may be appropriate to transport the patient from the home for immediate medical attention. Dr. Spears concentrates on providing medical care in the home, and consequently does not also treat patients in the hospital. However, he does work cooperatively with other practitioners and facilities, in order to provide well coordinated care.
May I get prescriptions refilled between home medical visits?
It is best to review and refill all necessary medicines at each home visit. Occasionally a refill or renewal is overlooked between visits. In that case, please leave a message on our automated answering service, including the following eight pieces of critical information: the patient's name; date of birth; name of medicine; strength and frequency of medicine; 90 day supply if desired; name and telephone number of pharmacy. (If you are a caregiver, recognize that the patient will probably need help with this.) Please note that we can only fill controlled substances face to face, during visits.
How can I find a physician like you where I (or my loved ones) live?
Dr. Spears provides health care services in the Long Island, NY, Boston, MA and Bethlehem, PA regions. If your life circumstances are located in territories not included in the areas Dr. Spears covers, but you have a need for home visiting health care, Dr. Spears suggests referring to the American Academy of Home Care Medicine and clicking the “Locate a Provider” link.