How a doctor leverages technology to bring house calls into the 21st century

By Carley Thornell | June 3, 2020


As visit volume typically predicates profitability, the duration of most primary care appointments hovers around 15 minutes. But longer appointment times can provide opportunity for a more comprehensive approach, with care that often includes in-depth mental health screenings and nutritional counseling, for example. Dr. Jesse Sadikman of Congressional Medical Group in Maryland transitioned his traditional primary care practice to a direct primary care model in 2019 in order to build stronger patient relationships that correlate with more specialized care. His 3,000-patient roster was whittled to 320 patients and Sadikman says that he’s more satisfied.

His “subscription”-based model includes a monthly fee that entitles patients to 10 office visits a year, an annual physical with lab tests and bloodwork, in-hospital and in-home visits, and Dr. Sadikman’s personal cell phone number. Here he shares insights on how his business model has been able to remain financially stable during COVID-19, and more:

How does athenahealth help you in your direct primary care model?

The fact that athenaOne is cloud-based and there is a mobile application, it’s been very helpful, and I use it all the time. When I’m talking to patients on my phone, I’ll pull up athenaOne and look at it. Part of my model is I do offer house calls. I’ve done that several times and been able to connect on my iPhone or my computer. And I’ll have basically everything I need to make an informed visit and make informed decisions based on the patient’s health record. In my old practice, we had an electronic medical record that was on a (physical) server and it was not good.

One of the reasons I loved athena to begin with is that the software is very user-friendly for the doctor. I think it opens itself up to alternative models like mine. The whole world is becoming more mobile, right? And, obviously, the coronavirus is going to change to a big degree how care is delivered. So, the more integrated you are, the better.

What are your coronavirus-related challenges and how have you solved them?

We’ve been doing more telehealth and phone calls and some Facetime chats [integrated with the athenaOne mobile app]. I’m still seeing patients in the office if need be and testing people if need be. I’m certainly glad I made the transition when I did because my revenue isn’t dependent on office visit volume.

Now, if I had a traditional — especially family — practice, it would be really hard to make ends meet. I didn’t apply for any COVID-19 loans because it hasn’t really changed my business model. There was one patient I called and he said he’s not making any money now. His quarterly payment’s due and I told him it’s fine, not to worry. But again, I have the ability to make those decisions because I own the practice and it’s not fee-for-service.

Besides more autonomy, what other reasons did you transition to a direct primary care model?

Even with value-based care initiatives (introduced), the financial models are still primarily fee-for-service. And it was just harder and harder for me to really make ends meet. Because of the volume of patients I had to see on a daily basis, I felt like it was compromising my care. I don’t disagree with value-based care — but I wanted to remain a small practice. I felt like the numbers were sort of getting mismatched and weren’t representative of the care I was giving. And I would be penalized if we were costing Medicare or [insurance companies] more money. I didn’t want to look at my patients like commodities. It would make me physically ill to look in my numbers and then say, ‘Okay, my patients may be costing [carriers] more. Therefore, I’m not a good doctor. It doesn’t make sense. So, I’m really much happier now.

So you are more satisfied with the quality of care you provide — and how you provide it — today?

Accessibility to me is part of my model. There are more phone calls out of the office than before. Patients want that and expect that. But I’m happy to do it now that I have fewer patients. I have the time and I have my phone on me all the time anyways. Prior to my transition, patients would get sick. Someone would go to the hospital. I wouldn’t even know about it. That was especially important when I was actively involved in valued-based care models. It was critical because you could manage a lot of stuff without them going to the ER.  I am doing more [after-hours calls] now, but having a mobile application baked into athena really helps.

In what ways has athenaOne helped your patients that another technology solution may not be able to offer?

When patients are in this model and paying for this service, communication is key, right? They want to feel connected to their doctor. I think from the patients’ perspective, the portal is very good. Having everything through the portal means it’s documented for me, too. A lot of my patients are engaged, and I consistently get reports that they like it.

I think that’s actually one thing that’s positive that could come out of this pandemic is having the ability to communicate better, to do telehealth visits. I anticipate I will probably do more of that moving forward, which won’t be a bad thing.

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