Seen at least once a week
Every patient is seen a minimum of once a week, and more often when the situation calls for it. That kind of consistency is rare after a discharge, and it is what catches a problem while it is still small.
Home/The Difference
Why Home Doc
Care that fits your life, not the other way around.
Most practices see you when a slot opens. Home Doc sees every patient at least once a week during the period when it matters most, and works alongside the doctor you already have.
Weekly clinician visits by telehealth, coordinated with your existing care team.
How we work
Two things that make the difference.
We work with your doctor
Home Doc does not replace your primary care physician. With your authorization we coordinate closely with them, so your care stays seamless and nothing falls through the cracks between visits.
The window that matters
The first thirty days after a discharge carry the most risk.
Follow-up appointments can be weeks out. Medications have changed. Symptoms are still moving. That gap is where readmissions happen, and it is the gap Home Doc was built to close, with short-term clinician oversight until a patient is stable and ready to hand back to their established providers.
There is no minimum length of service. Some patients need two weeks until they see their own doctor. Others stay on for ongoing psychiatric or palliative support, or come back when they need to. Transitional primary care explains how the handoff works.
20%
Medicare patients rehospitalized within 30 days
New England Journal of Medicine, 2009
4%
Among Home Doc transitional care patients
Home Doc internal data, not a controlled study
Jencks, Williams and Coleman, Rehospitalizations Among Patients in the Medicare Fee-for-Service Program (New England Journal of Medicine, 2009) found 19.6% of Medicare patients were rehospitalized within 30 days; more recent federal data puts the Medicare rate closer to 17%. Home Doc's figure reflects its own transitional care patients. The two are not a like-for-like comparison, and individual results vary with diagnosis, treatment plan and circumstances.
Real patients, real results
The difference this makes.
Three patients whose course changed under weekly telehealth oversight. Details have been changed to protect patient privacy.
Psychiatric care
From discharged and isolated, to attending family events
A patient in their mid-thirties with schizophrenia had been dropped by multiple practices for missed appointments. Severe paranoia made in-person care nearly impossible, and they rarely left home. Through consistent telehealth visits we built trust, adjusted the medication regimen, and reduced unnecessary medications over time.
Where they are now
Goes to the grocery store with family. Attends family events they previously avoided entirely. Engages comfortably in conversation during visits, a major shift from barely making eye contact at the start.
Palliative care
A routine weekly visit that may have saved her life
A patient in her sixties with metastatic pancreatic cancer was on chemotherapy and followed weekly through telehealth. During one routine visit she appeared newly confused and had a low-grade fever. Concerned about infection, her clinician contacted the oncology team immediately and arranged a same-day evaluation.
The outcome
Blood cultures confirmed a serious bloodstream infection. She was admitted, treated with IV antibiotics, and recovered fully, with her next chemotherapy cycle proceeding on schedule. The weekly check-in caught it before it became life-threatening.
Transitional primary care
From eight hospitalizations in a year, to walking with a walker
A patient in her sixties with kidney failure, COPD, type 1 diabetes and severe hypertension had been hospitalized eight times in the prior year. Hospice had been recommended, but she wanted to keep going. She had multiple specialists, and little had changed, because her conditions were too complex for any one of them to take ownership. Home Doc did.
Ten months later
One hospital admission. One emergency room visit. She went from bedridden to walking short distances with a walker, and continues to say how much the frequent oversight and individualized care has changed her life.
These accounts describe the experience of individual patients. Details have been changed to protect patient privacy. Outcomes depend on each person's diagnosis, treatment plan and circumstances, and no particular result is promised or implied.
What this looks like in practice
Care shaped around what you actually need.
A short-term bridge
Only need a week or two until you see your own doctor? That is exactly what this is for.
Alongside your PCP
Already seeing your primary care doctor but want weekly oversight on top of it? We continue alongside them.
No delay for home health
Starting home health without a PCP, or unable to get in to see yours? We can step in as the overseeing clinician so nothing waits.
Long-term, or on and off
Stay long-term, or discharge and come back when you need to. No minimum, no penalty.
A first conversation
Tell us what happened this week.
Intake will talk through what you need, what your plan covers, and whether Home Doc is the right fit. Nobody is enrolled on a phone call.
Records go to intake@myhomedoc.com. Everything else goes to info@myhomedoc.com.