Business

Nurse practitioner launches Treasure Valley house call business

Briana Lamb was cutting an onion last month with a sharp, serrated kitchen knife when she accidentally sliced her ring finger.

“It started just gushing,” she said. “It was a total bloodbath.”

Lamb, a registered nurse, was able to slow the bleeding. She knew she needed stitches immediately. But she didn’t want to drag her 7-year-old twin daughters to the emergency room. Urgent care clinics were closed for the night. And her husband, a wildland firefighter, was out of town.

Then she remembered: Bradley Bigford, a nurse practitioner Lamb used to work with, had just opened a business making house calls to people. Lamb found a social media post mentioning the business — Table Rock Mobile Medicine — and reached out.

Bigford came to Lamb’s house and stitched her up.

IT STARTED WITH A FACEBOOK POST

Bigford, a nurse practitioner for three years and a registered nurse for 10, works full time for the Ada County Sheriff’s Office, seeing patients at the Ada County Jail.

When family members came to town about a year and a half ago, he did an impromptu earwax-cleaning session for them and joked on Facebook about starting an ear-cleaning business. The eager responses to that offhand post made him think, “Wow, there is such a demand in the Valley for someone who can see them in their homes,” he said.

Bigford called the Idaho Board of Nursing and talked with lawyers. There seemed to be no barriers to an independent practitioner seeing patients in their homes. He found insurance billing codes specific to in-home visits.

Table Rock Mobile Medicine is not the only business that has offered to see Treasure Valley patients in their homes. Among them are a small but growing number of local doctors who have opened “concierge” businesses, offering a nearly unlimited amount of primary care for a monthly fee, in some cases including house calls.

However, as far as Bigford knows, he is the only provider who does house calls at no extra charge and takes health insurance. Table Rock currently takes Blue Cross and Blue Shield plans, Medicaid, PacifiCare and plans that include the Idaho Physicians Network. It will begin taking TriCare Oct. 1.

A business called House Calls LLC was co-founded in 2012 by critical-care physician Steven Fuller and Boise State University professor and public health physician Uwe Reischl.

The business brought doctors to assisted living and retirement communities, specializing in the care of seniors.

Fuller closed the business in May, coincidentally at the same time Table Rock Mobile Medicine was starting. Fuller said he is moving to Pennsylvania this summer to become chief medical officer for a large nonprofit senior housing corporation.

‘ALL THESE THINGS ... I’VE BEEN TRAINED TO DO’

Bigford’s scope of practice is broad, covering problems that often send people to their doctor’s office or walk-in clinic, such as urinary tract infections, respiratory ailments, rashes, ingrown toenails and ear infections.

“All these things that are in my bag of tricks to do, I’ve been trained to do that, and I’ve done it many, many times,” he said.

“There are a couple things I can’t do. I can’t take people in a medical emergency. ... I don’t prescribe narcotics or controlled substances.”

If a patient has a head injury and needs a CT scan, they should go to the emergency room, he said. And while Bigford is a family practitioner, he would not deliver a baby at a patient’s home.

Bigford said patients often ask whether what he’s doing is legal. As a nurse practitioner in Idaho, Bigford can treat patients without physician oversight, doing anything he is trained to do, from prescribing to ordering X-rays or running lab tests.

Bigford either bills health insurance or offers a 50 percent discount for cash payments, if a patient cannot or does not want to use health insurance. Bigford’s wife, a registered nurse who works for Saint Alphonsus Health System, helps manage the business.

OLD-FASHIONED WORD OF MOUTH

So far, most of Bigford’s business is coming from friends and colleagues.

Jessie Ruffing, 32, of Boise, went to high school with Bigford and saw him promoting his business on Facebook.

“I thought it was an incredible idea,” she said.

Ruffing has called Table Rock Mobile Medicine four times — three for her son’s ear infections, and one for her laryngitis that she worried might be strep throat.

She paid for the visits in cash, because Table Rock was not yet contracted with her health insurance plan. The cost was about $10 more than her copay would have been at a brick-and-mortar office, she said.

“It was worth it, not having to wait in a waiting room at a doc-in-the-box [where] I have to get both of my kids in the car, and sit and entertain them,” she said. “Literally, all I had to do was answer the door.”

One of Bigford’s co-workers at the jail, administrative employee Amberine Mowjee, decided to try Table Rock Mobile Medicine when the Ada County Sheriff’s Office promised Fitbits to employees who completed a biometric screening.

Bigford did Mowjee’s screening at her home in Meridian last month. She wanted an early appointment, so he arrived at 7 a.m., she said.

During the visit, Mowjee told Bigford she had been feeling lethargic lately. The 24-year-old would come home from work and spend the rest of the night lying down.

“He took my thyroid level, my TSH level, and it came back a lot higher” than it should be, she said.

Bigford prescribed her a low dose of thyroid medication and told her to check in with him or another provider a few weeks later.

“I was like, ‘Whoa, this completely explains my symptoms,’ ” she said. “I went later that day and picked them up.”

AN OLD IDEA RESURRECTED

Lamb, the woman who sliced her finger, said Bigford showed up within 20 minutes. “He shot me up with lidocaine [to numb the area], and I didn’t feel a thing,” she said.

It took 15 or 20 minutes to stitch her up. The next day, Lamb received an email to fill out paperwork so Table Rock Mobile Medicine could bill her health insurance, which ended up covering part of the charge for the visit.

“I owe him [about] 130 bucks,” she said. “Totally worth it.”

Bigford said his goal is to break even this year — a goal he expects to reach within a few months. Overhead is low, he said. His largest expense is $2,500 a year for medical malpractice insurance. He makes about $320 a week after expenses with the home-visit business.

He plans to keep his jail job. He said he loves it. He expects to be able to see two or three Table Rock patients a day in his off time. He might hire another registered nurse or nurse practitioner to help see patients if the business booms, he said.

He does not have a target for revenue or profits. He hopes to stay profitable enough to continue operating.

“My goal isn’t to make $250,000 a year,” he said. “My goal is to treat people, make a little bit of money, and do what I like to do.”

Audrey Dutton: 208-377-6448, @IDS_Audrey

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