The Doctor Still Makes House Calls
Two or three Wednesdays a month, Steve Butzon, O.D., finds challenges and profits as a road warrior.
By Jim Thomas, Executive Editor

"As a young lad, I traveled with my father, Dr. Rod Butzon, to make house calls in rural North Dakota," recalls Steve Butzon, O.D. "I remember we visited a patient who repaired clocks. On that visit, the patient was so grateful that he gave my father a clock, which I carried in my lap the whole ride home."

The visit made a lasting impression on the child and years later, Dr. Butzon followed in his father's footsteps. A graduate of the Illinois College of Optometry (1986), the younger Dr. Butzon manages two practices in the Chicago metro area - DuPage Optical and Wooddale Eye Clinic.

And for the past 17 years, he has made house calls. These visits carry on the elder Butzon's tradition of concern and compassion, but they're also professionally challenging and profitable. "It's exciting to treat esoteric pathologies that you would never see in practice," says Dr. Butzon. "And you receive a good fee for your time."

Dr. Steven Butzon makes house calls one or two Wednesdays a month.

Anatomy of a road trip

While the fees are attractive, making house calls is a specialty that requires skills beyond traditional patient care and practice management expertise. For example, the traveling doctor must learn how to integrate the house calls into an existing practice. Here's Dr. Butzon's system:

Each month, he sets aside two or three Wednesdays for house calls. Beginning at 8 a.m. and ending at 6 p.m., he'll travel to eight destinations to perform exams. For efficiency, he visits patients within the same area (he divides Chicago and the metro area into four quadrants) and he allows between 20 minutes and 30 minutes travel time between each appointment. He typically drives between 80 miles and 120 miles on a "house call day," he says.

"It's not difficult to cluster patients when you plan ahead," says Dr. Butzon. "Most patients can wait a few weeks. If there's an urgent need, we'll visit the patient within 24 to 48 hours."

Though he doesn't have the luxury of utilizing a full office on the road, a 2001 Town and Country minivan suffices; Dr. Butzon still provides comprehensive eyecare. "You can't just say to a patient, 'You'd benefit from a low vision aid,' and then not offer one. I have standing orders with M.D.s for medications I can't provide. I treat patients who have a wide variety of eye problems such as glaucoma, macular degeneration, neurotrophic corneal ulcers, dry eyes, cataracts and ocular allergies to name a few. When I'm beyond my capabilities, I'll refer the patient to a surgeon in their local area."

His care doesn't end at the referral. Dr. Butzon will make arrangements for his patient's transportation, which can become complicated when patients require special equipment, such as a gurney, for the move. "With surgery, I'll also see the patient post-op to limit the number of visits," he says.

	The equipment of a traveling optometrist

How to build a patient base 

Dr. Butzon says there are a number of ways that optometrists can build a base of patients who require in-house care. These include marketing with brochures and business cards, and receiving referrals from staff and patients. Dr. Butzon also networks with organizations that serve the homebound, such as

• physicians groups
• hospitals
• government agencies
• other groups that provide services to the homebound.

The Illinois Optometric Association also refers patients to him. Dr. Butzon avoids providing care in hospitals and nursing homes because "they already have access to healthcare."

"I restrict my visits to the homebound and private patients," he says. "Nobody is out there providing eyecare service to patients in their homes."

The average age of Dr. Butzon's house call patients is 82 years old and his oldest patient is 106. The majority of his house call patients are female.

Tough work pays off

Not every doctor may have what it takes to provide home-based healthcare, cautions Dr. Butzon: "You need to be physically fit. Some patient are in positions where they can't move, so to accommodate them you bend over the bed or get on knees or contort your body. You also have to be prepared to lift patients."

In addition, doctors must be prepared for the travails of life on the road and expect the unexpected to happen. "You need patience and nerves of steel," says Dr. Butzon. "You need to expect the unexpected, like a flat tire in the middle of your day. You can't let it bother you when you wind up paying $150 to retrieve your car after it was towed. And you rarely cancel an appointment - regardless of rain, sleet or snow."

And unlike the office, the traveling doctor has no way to control conditions. "I've visited patients who have butlers and those who live in squalor where I've seen rats and roaches," he says.

It also helps to have a good sense of direction, the doctor adds. The reward for this dedication can make a practice management consultant's mouth water: Dr. Butzon charges $209 for a house call eye exam, of which he bills $159 to Medicare using the E/M codes for house visits. The patient is responsible for a $50 refraction fee. The patient also pays for eyewear, contact lenses, low vision aids, etc. Dr. Butzon says his net income for house calls approaches 80%.

"House calls are more of a service, you're not fitting everybody with glasses," says Dr. Butzon. "So about 20% of the gross goes towards expenses including materials, gas and tolls."