World class Pulmonologist: comes to you at home

Finding a great Pulmonologist is hard.  Discovering a top Pulmonologist who will see you at home – priceless.  

When you can't breathe well, traveling to any doctors appointment is difficult.  Pulmonary cases become even harder to manage.  That is why HCDTO offers pulmonology and critical care as part of our concierge primary care.  We spotted the need because HCDTO also manages complex cases. Every patient is seen at their home.  

The MDs manage pulmonology, critical care (including related cardiology concerns) and your overall primary care at home

HCDTO is the only primary care group structured this way anywhere in the  Western USA. *  

When the medical issues are complex you want a primary care group with these skills on staff.  Because when it’s complex, it’s time to pay attention to the entire patient. 

This concierge medical group will help you find the right answers even if you are coming home from the hospical or ICU. We are experts who manage and arrange the right care at your home, answer your family's questions and help your insurance company agree to the right medical equipment or ongoing treatment.

Everything we do here starts and ends with the same question: "how is this best accomplished remotely, at home, in the patient's own environment?”

Then we ask that same question again,  adding in the needs of complex cases.

 HCDTO won approval for the very expensive lateral rotation bed pictured above as medically necessary.  Getting that through California Medi-Cal is an unbelievable success for our patient. 

Winning approvals through insurance can be detailed and time consuming.  HCDTO does this well.

As quick examples of our 

extra effort:

• Oxygen may be needed sooner than insurance will approve. 
• Lateral rotation bed (photo above) may be needed for an immobile person (can be $7,000 to $32,000+ paid by insurance).
• Low air loss mattress to reduce risk of pressure ulcers ($2,000 to $5,000 through insurance).
• Shift nursing waiver for better management at your own home vs a treatment in a nursing home.
• Specialist coordination for patients who don’t transport easily.
• Orders to Physical Therapists capable of the most complex cases.

As an example of why that matters, look at pressure ulcers and a Lateral rotation bed. That bed rotates left and right about every 20 minutes so that -- when you can’t move --the bed helps avoid a pressure wound on your body. 

No family on it’s own can reposition a patient every two hours, 24 hours a days, for weeks, months, or years on end. No one. 

Meanwhile, treating and curing the average Stage 4 pressure ulcer costs insurance about $240,000 (per NIH).  

Getting the most recent Lateral bed approved took:

• three face-to-face MD visits at the patient’s home, 
• six hours of MD's time to write and re-write the medical necessity AND appeal the insurance decision,
• with 21 pages of supporting chart notes. 

That’s not happening at the usual clinic or doctors office in a 12 minute appointment as expected by insurance. 

HCDTO can get it done.

Our physicians manage complex cases at home, including “Dr Ian” who is a board certified Pulmonologist and specialist in Critical Care Medicine.  

Some medical problems make it difficult for you or a family member to get the best care.   The challenges include weakness, exposure risks around other ill people, transportation, AND the missing detailed MD discussions around next steps that meet your goals. 

All of this is easier when a Pulmonologist CAN COME TO YOUR HOME and also manage your Critical Care needs.

 Next steps can be challenging after your hospital discharge to home. Your needs will change at home from a hospitalization on the telemetry floor, or the ICU, with multiple problems or even critical problems.

 * Could be further, 

but we stopped looking after 15 states.

A complex patient of ours was in the hospital and needed IV antibiotics. The hospital’s answer was discharge to home and administer “Brand X” as an IV antibiotic three times per day for two weeks.   They are used to having lots of nurses available in the hospital for that schedule.

However, trying to schedule nurses 3x per day at home is a massive challenge for both insurance and skilled nursing.

Instead our medical group went back to the hospital and the insurance company with a different idea. HCDTO proposed a different antibiotic that only had to be given ONLY ONCE every seven days. That's only twice at home. 

Easy to do. Easy to manage. 

Our doctors have the experience — and the time — to think several steps ahead.