News

From ER to ‘country doctors’
(by Maggie Fazeli Fard - February 06, 2008)

As the region waits with bated breath on the fate of the former Pascack Valley Hospital (PVH), two former PVH emergency room physicians have embarked on a new medical venture: treating everything from sprained ankles to food poisoning in the comfort of a patient’s home.
“We saw a need,” said Dr. John Hallenbeck, who along with Dr. Ken Cartaxo launched Urgent Care House Calls last Thursday.

The doctors, who have 35 years of ER experience between them, now make house calls to treat minor emergencies that are too serious to be handled in primary care doctors’ offices but that don’t warrant a trip to – or a long wait in – the emergency room.

“The reality of the matter is the other hospitals are not located in a reasonable distance,” said Hallenbeck. “What’s a reasonable amount of time to wait when your kid has a cut and is in pain?”

Hallenbeck and Cartaxo found themselves haunted by questions like this as PVH stood on its last legs in 2007. In the weeks before the hospital closed, the physicians began diverting patients to other hospitals.

“Just hearing people accept calls, they were inundated,” recalled Cartaxo, who has worked in emergency rooms for 23 years and was at PVH from 1988 to 2007. “The waiting times were unreasonable. The need was there for these acute medical needs.”

Cartaxo met Hallenbeck about one year ago when the 12-year ER veteran joined the PVH team after his former employer, Passaic Beth Israel, closed. “We just seemed to click,” said Hallenbeck, who lives in Montvale. “We both knew we wanted to do something. We just didn’t know what.” They briefly considered opening an urgent care center, but it didn’t take long before Cartaxo recalled a newspaper article about house calls that he had read several years earlier.

The more the pair looked into starting the service, the more it seemed like a viable option. “The majority of emergency room patients came in with minor emergencies,” but they would sometimes have to wait several hours before they could be seen, Cartaxo said, noting that serious emergencies take precedence over minor ones like lacerations or flu symptoms. PVH’s closing, he added, has aggravated the situation, as more stress is put on the ERs of other area hospitals.

“If you cut your hand while making breakfast, do you want to spend the whole day in the ER?” he asked. “We can decompress some of the emergency rooms.”

In addition to lacerations, Cartaxo and Hallenbeck will treat simple infections, sprains and vomiting, and can administer medications and IV hydration. They will be on call 24 hours a day, seven days a week at 1-888-DRHC247, which they hope people will remember by memorizing “1-888-DR House Call 24/7.” Blood work and x-rays are not currently available, but the pair is confident that they will be able to offer portable tests in the future.

Cartaxo also hopes to incorporate nutritional medicine. “I think the pendulum is swinging back from high technology to more natural treatments,” he said. His first call on Thursday, Jan. 31, involved dispensing a vitamin cocktail through an IV.

“The country doctor,” Hallenbeck said, jokingly nodding towards his business partner. Cartaxo agreed that people think that house calls are “a thing of the past.”

“It’s a losing proposition for primary care physicians,” Cartaxo said. “We don’t have any office or staff. In private practice your biggest expense is your staff. Our overhead is much less.”

The cost of a basic house call is $250; a follow-up costs $195. Hallenbeck said that the cost of an evaluation by a physician in an emergency room runs about $300, excluding hospital and treatment fees. “The ER is the most expensive care being offered. The fees are steep.” Hallenbeck added that while it’s cheaper than going to the emergency room, the waiting times for doctor’s appointments can be two or three days and the doctor’s practice is not always equipped to handle minor emergencies. Doctors very often instruct patients, especially those who call at odd hours, to go to the emergency room. “We’re basically going to take people with minor emergencies that small doctor’s offices can’t handle,” said Hallenbeck. “And it’s one-on-one while in the ER it could be one-on-20.”

The doctors plan to work with local doctors, giving them an alternative to sending people to the ER while giving detailed follow-up reports on treatment provided during the house call. They also plan to contact visiting nurses who care for homebound patients as well as local hotels, where guests may be far from their home physicians and need assistance with issues such as minor food poisoning.

They stress, however, that they are not aiming to take the place of primary care physicians nor that of emergency room care. If anyone calls them complaining of labor pains, chest pains, numbness or uncontrollable bleeding, they will instruct the caller to hang up and call 911.

Similarly, they have no qualms about calling paramedics if they arrive on a scene and deem the situation needs emergency care. “A non-life-threatening emergency could become life threatening,” admitted Cartaxo.

In the end, the house call service boils down to two energetic doctors with time on their hands and the desire to help their community. “I enjoy seeing people and really helping them. Now that the ER is gone, we can do it in a way that is satisfying to the patient and to us; to provide care the way we’d want to be cared for.”

To contact Dr. John Hallenbeck or Dr. Ken Cartaxo at Urgent Care House Calls, call 1-888-DRHC-247 (1-888-374-2247).

Maggie Fazeli Fard's e-mail address is fazelifard@northjersey.com

 

FOR IMMEDIATE RELEASE
February 27, 2008 

DISPLACED ER DOCS DELIVER HIGH-QUALITY URGENT CARE TO NORTH JERSEY DOORSTEPS

Round-the-clock house-call practice serves communities left in the lurch by Pascack Valley Hospital closing

KINNELON, NJ –

Doctors Kenneth Cartaxo and John Hallenbeck, board-certified emergency room physicians, today announced the creation of Urgent Care House Calls, a unique practice providing convenience and personal service for minor medical emergencies in patients’ own homes.

Cartaxo, of Kinnelon, and Hallenbeck, of Montvale, practiced emergency medicine at Pascack Valley Hospital in Westwood until the facility was forced to close last November. With North Jersey residents faced with increased travel and extended wait-times in the ERs of surrounding hospitals, Cartaxo and Hallenbeck offer an attractive and cost-effective alternative to traditional emergency room care.

“The need for quality urgent medical care in Northern New Jersey is obvious and the closing of Pascack Valley and other area hospitals means the time is right to offer a new and different solution to area residents,” said Dr. Cartaxo a 19-year Pascack Valley ER veteran.

“To continue to care for this community without the burden of third-party payers and hospital bureaucracy is both an honor and a blessing. House-call medicine provides us with the opportunity to connect with patients in a way we rarely experienced in the emergency department because of time constraints,” he said.

With fees starting at $250 per visit, Cartaxo said Urgent Care Housecalls fees are a fraction of what the same service would cost in traditional hospital ER.

“Most minor emergencies can be cared for without the trappings and high cost of an ER. Patients get the prompt, professional treatment they need without the aggravation and exposure to communicable diseases present in overcrowded ER waiting rooms. We respond within the hour while the average wait-time for minor emergencies in the ER is nearly four hours.”

Urgent Care Housecalls physicians will visit area homes, offices and hotel rooms to provide personalized medical care They will treat adults and children with minor lacerations, sprains, minor infections of the throat, ears, lungs, urinary tract and skin, as well as vomiting, diarrhea and dehydration. Medications and IV fluids also can be provided at the time of the visit and many tests can be performed.

For more information about Urgent Care House Calls or to schedule an appointment, please call 1-888-374-2247 anytime of the day or night.

 

Sit back and dial a doctor
Physicians bring urgent care from ER to LR (living room)
Monday, April 21, 2008
BY ANGELA STEWART
Star-Ledger Staff

Reeling from abdominal pain one recent morning, Diann Isola dreaded the thought of dragging herself to the local hospital emergency room.

"You wait for hours and you never know what you are going to catch in the waiting room," said the 45-year-old Kinnelon resident.
Isola decided to take another route.
Recalling an ad she'd seen in a community newsletter, she dialed the number for an emergency house call service. Within an hour, a doctor was sitting in her living room.
"I called him at 10 o'clock and he was here by 11," she said. "He had a little black doctor's bag just like one would expect."
The doctor, Kenneth Cartaxo, started Urgent Care House Calls with another emergency room physician, John Hallenbeck, in January. Both had worked at Pascack Valley Hospital in Westwood until it closed in November.
Cartaxo, 54, of Kinnelon, had been at the hospital almost 19 years. Hallenbeck, 43, of Montvale, had been there less than two years, although he worked earlier in the emergency departments at St. Joseph's in Paterson and the former Passaic Beth Israel.
"There is so much change going on in hospitals in New Jersey," Hallenbeck said. "We have very little job security."
Figuring the local emergency rooms would be inundated after Pascack's closing, as well as that of Barnert Hospital in Paterson, which was scheduled to shut in three months, they came up with an idea to offer personalized emergency care service in the privacy of the patient's home.
Targeting problems ranging from cuts and sprains to minor infections and viruses, Cartaxo and Hallenbeck were hoping to appeal to people's desire to have their emergency get priority status
"In the ER, I have 20 people waiting to come in and I am rushing around trying to give everybody quality care," Cartaxo said. "In this situation, there is one patient and one doctor and I can focus."
While no one expects this kind of home-based urgent care to replace emergency rooms, experts say what these doctors are doing is actually a throwback to how medical care used to be delivered.
"It's going back to an earlier era when, if you could afford it, doctors came to you," said Fred Hyde, a clinical professor at Columbia University's Mailman School of Public Health. "You didn't go to doctors."

CONVENIENT AND EFFICIENT
Patients pay a flat $250 fee for the house call, and the doctor provides them with the necessary forms to submit to their insurance company. Aside from home visits, the pair will also go to hotel rooms, businesses and even nursing homes.

"Most minor emergencies can be cared for without the trappings and high cost of an ER," Cartaxo said.
They also carry an assortment of common antibiotics and pain medications. Isola, who was suffering from an inflammation around her intestines, was prescribed two different antibiotics by Cartaxo and paid wholesale price -- $18 for both -- for a 10-day supply. Cartaxo also arranged for her to undergo a CT scan at a local hospital, even obtaining pre-authorization from her insurance company. She walked right in and was seen.
On a follow-up visit a week later, Cartaxo re-examined Isola and discussed her test findings. That visit cost $195.
"I would definitely use them again," she said.
Retired police officer George DeGiovanni, 55, of Park Ridge recently used the house call service for a back problem.
"You get to the point where you bend or move the wrong way and it goes out," he said.
His wife, Kerry, said there was no way she could even have gotten her husband into the car because he was in such pain. Hallenbeck arrived at their door within a half hour of their call.
He gave DeGiovanni an injection of a pain medication, as well as an oral muscle relaxant. Hallenbeck also wrote a prescription for a pain medication and called it into the pharmacy. He also showed DeGiovanni some exercises he could do at home.
"He has even called me twice now to see how I am doing," DeGiovanni said.
The doctors carry malpractice insurance and the joint policy for their house call service is $20,000, which is a part-time rate.
And because they are still building the practice, both have taken positions as emergency physicians -- Hallenbeck at Meadowlands Hospital and Cartaxo at Newton Memorial.
They arrange their schedules so there is always 24-7 coverage for the house call service.
As business picks up, Cartaxo and Hallenbeck said they hope to hire more doctors so they can treat patients outside of Morris, Bergen and Passaic counties, which is their primary coverage area.
John Sensakovic, associate dean of graduate medical education at Seton Hall University in South Orange, said as hospital emergency rooms become more crowded and an increasing number of people use them for primary care, urgent house calls could become more popular.
"They may be on the cutting edge," he said.

-------------------------------------------

Daily Record   May 18, 2008  Page: COMMUNITIES22

Calling Dr. Cartaxo, calling Dr. Hallenbeck
MICHAEL SCHOLL DAILY RECORD

KINNELON -- The old-fashioned doctor's house call is making a comeback in Morris County, thanks to two veteran emergency room doctors who have started a new business in which house calls are their specialty.
Drs. Kenneth Cartaxo and John Hallenbeck, board-certified emergency room physicians, started Urgent Care House Calls at the end of January. It's a unique practice providing convenience and personal service for minor medical emergencies in patients' own homes.

Cartaxo, a Kinnelon resident, said he and Hallenbeck, of Montvale, worked as emergency room doctors at Pascack Valley Hospital in Westwood until the facility was forced to close in November because of financial troubles.

The closure led to an increase in the emergency room patient caseloads at other North Jersey hospitals, with wait times of four hours or more becoming commonplace for patients.

While Pascack Valley was in the process of closing last year, Cartaxo and Hallenbeck realized that people would benefit from an alternative to a crowded emergency room. That alternative is the old-fashioned house call, which offers an attractive and cost-effective option for patients who want to avoid the long wait and travel time associated with emergency room visits.

Cartaxo said a house call is a viable alternative to the emergency room for treatment of many of the ailments that ER doctors commonly deal with. Many patients who come to an ER have problems that are not true emergencies, or do not need X-rays or other expensive tests, he said. Visits to an ER also can expose people to communicable diseases that may be carried by other patients, he added.

Cartaxo and Hallenbeck will provide personalized medical care for adults and children, they said.

Among the ailments the doctors can treat during a house call are minor lacerations; sprains; and infections of the throat, ears, lungs, urinary tract and skin. They also treat patients suffering from vomiting, diarrhea and dehydration.

The doctors carry many medications and IV fluids with them, and also conduct a variety of tests with the equipment they carry in their vehicles.

Although Cartaxo and Hallenbeck now work part of the time at local emergency rooms, one of them is always available 24 hours a day, seven days a week. They respond to homes, offices and hotel rooms throughout Morris, Bergen and Passaic counties, and generally can arrive at a scene within an hour of receiving a call at their toll-free number, (888) 374-2247.

The fee for an initial visit is $250, with follow-up visits costing $195 each. There are additional charges for suturing and the dispensation of medication.

Payment up front

Cartaxo and Hallenbeck require payment up front for their house calls and do not accept insurance, although patients can apply on their own to their insurance companies for reimbursement. The doctors do accept credit cards through the use of a portable credit-card reader that they can bring to patients' homes.

Cartaxo said they do not accept insurance because the administrative costs associated with processing claims would be too burdensome. Without that burden, the overhead costs for his and Hallenbeck's new business are relatively low, with their major expense being the cost of malpractice insurance.

The low overhead makes house calls economically viable for the team, whereas other doctors are burdened by the costs of operating an office and are forced to see a high volume of patients to cover those costs.

The need for high patient volume was what drove house calls out of fashion years ago. Now Cartaxo says the house call patients he has seen so far have been "pleasantly surprised" by his willingness to treat them in their homes.

He added that he likes house calls because they allow him to give individual attention to each patient and avoid the rush from patient to patient that comes with a shift in the ER.

"You can take your time and really get to know them," Cartaxo said. "It's very satisfying for the doctor as well as the patient."

Michael Scholl may be reached at (973) 428-6644 or mscholl@gannett.com.


Cartaxo and Hallenbeck require payment up front for their house calls and do not accept insurance, although patients can apply on their own for reimbursement. The doctors do accept credit cards through the use of a portable credit-card reader that they can bring to patients' homes.

Help on Wheels
by Jessica Kitchin
Posted October 14, 2008
Two New Jersey doctors see the wave of the medical future in the past.

Dr. Cartaxo visits Kinnelon resident Mae Jacobs.
Dr. Cartaxo's car contains a plethora of medical equipment, including—IV pole and fluid bags, suture and catheter kits, antibiotics, urinalysis and pregnancy tests, stethoscope, credit-card machine, and other items that would puzzle a passerby.
Photo by Colin Archer/Agency New Jersey.
One of these days, Dr. Kenneth Cartaxo is hoping to add a different type of jumper cables to his car trunk. It’s crowded back there, but he should be able to fit a portable heart defibrillator (which directs electrical energy to a struggling heart) amid the IV pole and fluid bags, suture and catheter kits, antibiotics, urinalysis and pregnancy tests, stethoscope, credit-card machine, and other items that would puzzle a passerby.
Cartaxo’s job as a house-call doctor combines a nostalgic concept of the family physician with a large dose of modern technology. (Fear not: Amid his collection sits a familiar black leather bag, à la Marcus Welby.) The 54-year-old Kinnelon resident joined with Dr. John Hallenbeck, 43, of Montvale, to start Urgent Care House Calls (urgentcarehousecalls.net) in January, three months after Pascack Valley Hospital in Westwood, where they were emergency-room doctors, closed.

In the months since, the two have been visiting patients, mostly in Bergen, Morris, and Passaic counties. “It’s a nice way to practice medicine, and it’s better for the patient,” Cartaxo says.
Take the case of Mae Jacobs. When Jacobs, 65, returned to her Kinnelon home after a ski trip, she needed medical attention to deal with a rash on her face. Dreading the idea of waiting in an ER or clinic, Jacobs called Urgent Care. Within twenty minutes, Cartaxo was at her door. He diagnosed her with shingles, a viral infection that had made its way into her cornea (and could have rendered her blind).

He set her up with a prescription, immunity-boosting vitamins, and an appointment with an ophthalmologist that day. She was quickly on her way to recovery. “There’s no comparison,” she says of her experience. “You’re not waiting for hours on end, you’re not dealing with a bureaucracy, and you’re able to sit down and have a doctor focused on you.”

The doctors admit business is slow, and it may take time to break even after their personal investments in equipment and malpractice insurance. Both work at hospitals to supplement their incomes. But as ERs get more crowded, they hope people will be inclined to call. “Ninety percent of the cases there aren’t true emergencies,” Cartaxo says.

If a patient does call with an emergency, the doctors will instruct him or her to call 9-1-1. But for sore throats, nausea, sprained ankles, even basic physicals—patients can spend $250 and see a doctor within an hour without having to get into a car. (A weekend and evening surcharge applies, and follow-up visits are $195.) The doctors do not accept insurance, but provide the necessary paperwork to file an insurance claim, which usually results in patients paying only the copay.

Hallenbeck says his ER time gave him incredible experiences. “But you don’t have the opportunity to spend a lot of time with patients, to get to know them.” As a house-call doctor, that’s changed.

For Cartaxo, the personal nature of house calls reconnects him with his early visions of medicine—and his days as a young EMT. “I’ve really come full circle.”
Link:http://njmonthly.com/articles/topdoctors/help-on-wheels.html?errors=socialweb_1