Visiting Nurse prescribes doctor house calls

These are interesting times for health care. One organization is experimenting with sending primary-care doctors into homes of seniors while asking visiting nurses to make fewer house calls.

Mark Oshnock

Mark Oshnock

And the moves appear to make financial sense over the long haul. Seriously.

Mark Oshnock, CEO of Visiting Nurse Health System of Atlanta, is no stranger to numbers-crunching. The former head of Arthur Andersen’s health care consulting business took over the non-profit organization six years ago, when it was deep in debt. A month ago, the final installment of the $20 million credit line was paid, freeing it to spend more of its resources on patients.

Oshnock, 55, has been able to grow the non-profit to a projected $55 million in revenue this year, from $32 million in 2004, by employing strategies used by for-profits. For example, he retreated from non-core operations, such as renting medical equipment. Instead, he focused on two key businesses — providing nurses and physical therapists to seniors leaving the hospital and providing hospice care for those with less than six months to live.

About two-thirds of the 660 employees are nurses or therapists. They treat about 20,000 metro area patients — and they have been immune to layoffs.

“Since I’m here, we’ve not cut anyone on the clinical delivery team,” Oshnock said. That’s because demand keeps rising, while the cost of hiring and training a new employee is expensive — as much as $30,000.

As the biggest non-profit for home health in the area, Visiting Nurse competes against two major for-profits. That’s where the experiments come in.

Oshnock said health care reform is putting pressure on Medicare, the biggest source of revenue, to cut costs. Nationally, Medicare is planning to cut its reimbursements for home care by 5 percent in 2011, followed by a 4 percent decline in 2012 and a 3 percent drop in 2013, he said.

To deal with the cuts, Oshnock is starting a call center, staffed primarily by nurses, to see if the average of 15 home visits following a hospital stay by a senior can be cut to 13. Service would be supplemented by phone calls and telemedicine, which tracks patients through monitors in their home.

At the same time, Oshnock is beginning to tackle another problem — seniors with several chronic issues who do not have a primary-care physician. When things go from bad to worse, they end up in the emergency room, driving up costs to an average of $40,000 annually for this group, Oshnock said.

“We believe we can drive down those costs significantly,” he said.

Visiting Nurse just started to send a primary-care doctor to visit such patients. The goal is for the doctor to assess the patient and set up a treatment plan. A nurse practitioner also is involved.

At first, the idea will lose money, with donors to Visiting Nurse picking up the $250,000 annual tab, Oshnock said. But he hopes that will change, as Visiting Nurse uses more doctors in homes and Medicare embraces the idea.

“In order to reduce overall health care costs, Medicare will need to get smarter,” Oshnock said. “We’ll need to use more doctors and nurses in the right settings to deliver the highest quality and most cost-effective care.”

- Henry Unger, The Biz Beat

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6 comments Add your comment


November 16th, 2010
7:26 am

Good, innovation is what we desperately need, but how can a senior citizen not have a primary care physician? Where in the world have they been? As clueless as we are, it’s a wonder medical care isn’t using up even more of our resources. I feel guilty for my bad decisions that have resulted in trips to the emergency room and hospitalization. I should be able to manage my chronic illness much better, but sometimes we are our own worst enemiy.


November 16th, 2010
8:04 am

I love this idea. I believe it is exactly what is needed for many elderly.

Ruby Huttner

November 16th, 2010
9:11 am

Idea won’t save money . Chronically I’ll individuals will end up being admitted to hospitals to a great extent. A lot of time efficiency will be lost sending highly trained individuals to people’s homes adding to unnecessary costs .


November 16th, 2010
10:10 am

If we eliminated 3rd party payer insurance (which is not insurance by any true definition), restored a free market in all insurance, especially for true insurance for crisis and high cost emergency situations, get every last shred of government out of the market, and generally turn medical care back into the competitive service business that it rightly is, house calls, responsive doctors, affordable care and the like would be available to EVERYONE.

Unfortunately we have believed the lies of the medical industry, the government, and every other vested interest looking for protection and now have a horrible health care system. And yes, it was horrible before Obamacare too.

As with everything, the problem is, has been, and always will be the presence of government in the market.

The free market is delivering better quality and lower costs in every other market in which the government is absent or only minimally involved. The same could be true of medicine if we would just have the courage to allow it to happen. Or at least the respect of our fellow citizens to allow it to work for those who want it.


November 16th, 2010
8:16 pm

I believe this is a very good idea. Most seniors do better in their own environment, their homes, apartments, etc..To have a Dr. check on them, plan for their care in their own homes is a wonderful idea. When you have retirement centers, nursing homes which cost up to $60,000, $70,000 or more a year for a seniors care, if it could be cut by half by being able to stay in their own homes, I would think this would be a plus for all. Something has to be done and this sounds like an interesting start on a different option for Health-care for the elderly at least.

Gillian Renault

November 18th, 2010
5:57 pm

TnGelding writes: ” but how can a senior citizen not have a primary care physician? Where in the world have they been?” Imagine you are 80 years old, living alone, and the one physician you trusted and saw for 25 years retired last year. You are afraid of going to a new doctor, and don’t know where to start. You now live in HUD housing. You can no longer drive. Your children live in other cities and say they don’t know who to recommend. You don’t think you can afford it anyway. You let it slide. You don’t feel sick, but your short term memory could be better. You let it slide some more. Now you are a senior citizen without a primary care physician.