House Calls StatUp Manual

How to Run a Low-overhead, High-profit Practice and Get Your Life Back

The latest version of the book that will get you started to a successful house calls practice is here, and as of today it is ranked as the #1 New Release in Physician & Patient Home Care on Amazon!

House calls may be the oldest form of health care delivery, but they are making a comeback. Why? Because it may be the simplest, fastest way to a highly profitable practice and great lifestyle. This book is the definitive step-by-step how-to manual for any doctor, physician or podiatrist who wants to shift from a standard-office based practice to a more profitable house calls based practice.

Here is the story about the book and how the author thrives in this medical practice model:

After completing comprehensive foot and ankle surgery residency training and winning multiple awards from the American College of Foot & Ankle Surgeons and the American Podiatric Medical Association, Dr. Christopher Segler opened a standard office-based podiatry practice immediately out of residency. Through hard work and creative marketing efforts, his practice grew rapidly, and he soon had a full schedule—too full, in fact. He found himself leaving for the hospital in the dark, sitting in the office charting on the weekends, and wishing he had more time to actually talk to patients.

Searching his soul and trying to determine what he wanted to do with the next phase of his career and his life, he made a list with two columns: "Everything I love about the practice of medicine" and "Everything I hate about the practice of medicine." After completing the list, he realized that a standard office-based practice had too many related items in the hate column and too few in the love column.

He then set about creating a practice that would include only items from the Everything I love column, and vowed never again to do anything from the Everything I hate column. The result was a simple fee-for-service, cash-based practice, free from insurance hassles. He opted out of Medicare, stopped accepting insurance, and jettisoned his office and all associated overhead.

The result of that bold move, was a period of fear followed by experimentation that eventually yielded a high-profit, low-stress practice. He now walks his son to school, travels extensively, and earns more money than he did from his previous standard practice, while working a fraction of the hours he used to put in.

This book shows exactly how he built his practice—and how you can, too. The reasoning behind opting-out of Medicare is explained. He outlines the methods he uses to attract patients who are willing and eager to pay on the spot for home-based care. He tells you best practices he learned through trial and error while he built his new model: what works and what doesn’t. If want to get your life back with a high profit, low stress practice, this book will save years of fear, help you skip the experimentation phase, and ensure that you land high on the learning curve so you can start earning a real living and live a great life, right now.

Order your copy of the Kindle version NOW!

Dr. Christopher Segler
Doc On The Run

If I Opt Out of Medicare Can I Still See Medicare Patients for Podiatry House Calls?

Yes! In fact far more profitably.

You can (and likely will) see Medicare patients if you opt out of Medicare. However you will not be restricted to charging Medicare allowable rates. You can charge whatever is appropriate for your time. You can charge a house call fee sufficient to provide caring, non-–rushed care for your elderly patients. And you will not have to wait for Medicare to pay you.


If you have previously accepted Medicare and then opted out of Medicare (after you realized that it was very difficult to offer high-quality caring interactions at low Medicare reimbursement rates), you must notify every medicare-eligible patient that you have Opted Out of Medicare. When you see a Medicare patient after you have opted out of Medicare you are entering into a private contract. The following are conditions and requirements of a private contract between the physician (you) and the Medicare “beneficiary” (the patient).

REQUIREMENTS OF A PRIVATE CONTRACT BETWEEN THE PHYSICIAN/PRACTITIONER AND BENEFICIARY:

• Be in writing in print sufficiently large to ensure that the beneficiary is able to read the contract
• Clearly state whether the physician or practitioner is excluded from Medicare.
• State that the beneficiary or his or her legal representative accepts full responsibility for payment for the physician’s or practitioner’s charge for all services furnished by the physician or practitioner.
• State that the beneficiary or his or her legal representative understands that Medicare limits do not apply to what the physician or practitioner may charge for items or services furnished by the physician or practitioner.
• State that the beneficiary or his or her legal representative agrees not to submit a claim to Medicare or to ask the physician or practitioner to submit a claim to Medicare.
• State that the beneficiary or his or her legal representative understands that Medicare payment will not be made for any items or services furnished by the physician or practitioner that would have otherwise been covered by Medicare if there was no private contract and a proper Medicare claim had been submitted.
• State that the beneficiary or his or her legal representative enters into the contract with the knowledge that he or she has the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted out of Medicare, and that the beneficiary is not compelled to enter into private contracts that apply to other Medicare- covered services furnished by other physicians or practitioners who have not opted out.
• State the expected or known effective date and expected or known expiration date of the opt-out period.
• State that the beneficiary or his or her legal representative understands that Medigap plans do not, and that other supplemental plans may elect not to, make payments for items and services not paid for by Medicare.
• Be signed by the beneficiary or his or her legal representative and by the physician or practitioner.

Here is a copy of the exact form I use to notify patients I have opted out of Medicare:

Medicare Opt-Out Agreement form

Please note: You are required to have your patients sign a new contract every two years.  I simply have every Medicare patient sign a copy every year whenever I see them.

Check with your Health Care Attorney to make sure you are in complete compliance.

KEEP ORIGINAL COPIES of forms!  Retained original signatures of both parties are required by the physician for the duration of the opt out period (as in forever). These must be made available to CMS upon request. Place a copy in the patients new patient folder at their initial visit before items or services are furnished to the beneficiary under the terms of the contract.

Dr. Christopher Segler is not a health-care attorney and is not offering legal advice.  However he is a successful Concierge Care House Call Podiatrist who figured out how to help patients by offering cash-based services free of insurance-related hassles under a simple house call practice model.  If you have a question about how to start a profitable, low-stress podiatry housecalls practice, you can reach him directly at 415–308–0833 

Do I Need an Office for Podiatry House Calls?

No.  And seriously...why would you want one?

To be realistic, lets look at what you get when you decide to set-up a podiatry office or store-front location. You now get to pay rent. You get to pay paychecks (that you write of course, out of your own bank account) to nurses, medical assistants and office staff. 

Then of course you will need insurance, too. So you buy renter’s insurance to insure the property in the office is covered against theft, fire, vandalism, etc. You will buy slip and fall insurance to protect you from the out-of-work opportunist/scam artist who perceives you to be rich and therefore someone who might want to pay out rather than fight a frivolous lawsuit. You will need to buy workman’s compensation insurance to cover the salary of that perpetually late and/or rude employee you need to fire. And let’s not figure waiting room furniture and all of those podiatry chairs that each cost about as much as a small car. 

If spending all of you income on an office fun to you, then by all means, open a brick-and-mortar podiatry office.

But if you plan on doing house calls, keep in mins that all of those expenses will cost you, even while not use...as in all the time you are out doing house calls. 

If your brick-and-mortar office overhead expenses run at $100 per hour than you have to make $100 per hour every hour while out of the office just to cover the office expenses. 

If your total office expense are more like $200-$500 per hour, better drive fast. 

When you eliminate all of that useless office overhead, it suddenly becomes much easier to make a real profit doing podiatry house calls. 

I am not trying to contend that office setting aren’t useful for most practices. I am only pointing out that when you choose a podiatry practice model based on direct pay, house calls and increased physician access, an office is a lability and not asset.

The podiatrist who believes he needs an office in which to see “serious cases” such as infections, diabetic emergencies and the like, is fooling himself. Serious cases don’t need an office, they need a hospital. 

Think about an urgent issue that a podiatrist discovers in a nursing home. The Podiatrist doesn’t take the nursing home patient back to the office...he treats the patient right there, or admits the patient to the hospital. 

This certainly more closely follows the course of a podiatry house call practice. 

You certainly need to consider whether or not your target market is really patients who want to visit an office for care, or patients who want to have their care delivered to them at home. 

If you think your market is BOTH, you will likely find little success in either. 

Choose wisely, but choose one. 

Dr. Christopher Segler is a podiatrist who started a house calls based podiatry practice from scratch. He designed an insurance-free practice model that works and is profitable much earlier than a conventional podiatry office practice model. After working out the kinks, you has shared his recipe for house call success with a limited number of podiatrist. If you are considering building a house calls based podiatry practice, and wonder if it would work for you in your community, you call reach him directly at 415-308-0833. 

10% of Docs Expected to Stop Taking Taking Insurance in Next 3 Years!

If there was ever a great reason for the timid to start a concierge podiatry practice, this would be it.

A recent article in Forbes discussed reasons why so many docs are planning to go insurance-free in their practices. It is not just fed-up, frustrated and overwhelmed primary care doctors. The AMA says it is across the board. All medical specialities have doctors who now believe running a practice free of third-party insurance reimbursement hassles is the most profitable and best way to go.

An independent research firm claims 9.6% of all doctors plan to switch to direct-pay models of practice in the next 1 to 3 years.

If you are a podiatrist who has historically relied on a group of primary care providers to funnel patients into your waiting room, this is good news.

Birds of a feather...

If you are the only podiatrist in your area who accepts NO insurance, you are the obvious best referral option.

Concierge docs are often viewed as forward-thinking independent risk takers. However the reality is that they aren't really taking big risks eliminating slow-paying third-party payments. They get paid immediately and consistently. The accounting is much simpler. The profit is higher. Life is better.

All of the decreases in time spent on the business side translate into increases in time on the patient care side. There is more time to research new procedures and better techniques. There is more time to respond to patient questions and make podiatry house calls for patients in your practice.

When a podiatrist opts-out of Medicare and stops taking insurance, the primary care doctors all know you are going to provide a higher level of attention than someone who is worried about reimbursement issues based on low-paying insurance contracts.  This alone would be reason enough for them to begin referring their clients to you for podiatric care.

So if you have been thinking about making the switch from a high hassle/low reimbursement model to a low-overhead/high satisfaction podiatry house calls practice, now would seem to be the time.

Dr. Christopher Segler used to take Medicare and insurance. But one day he woke up. After of years enjoying his podiatry house calls practice model in the San Francisco Bay Area, he has been approached by podiatrists all over the country asking one simple question, "Could a house calls based podiatry practice work for me in my area?" And the answer so far, in every case, has been YES! He now often helps other podiatrists set up and get their house calls practices started. If you have a question, you can reach him directly at 415-308-0833. You can view his practice websites at AnkleCenter.com DocOnTheRun.com and LaserToenailHouseCalls.com

Podiatry House Calls Practice How-To Blog

This blog will help you understand everything you need to set up your own highly profitable housecalls based podiatry practice. This practice model is feasible whether you're in a large city or a rural community. You just have to figure out whether or not this practice model is right for you.

If you are reading this, you likely fall into one of 2 groups.
1. Practicing podiatry for years and worn out with practice.
You have been practicing podiatry for many years and have recently realized that the high-overhead of a conventional practice is barely profitable when excepting continually and persistently decreasing reimbursement rates for your services paid by insurance companies.

2. Just getting ready to start a podiatry practice.
You have been working hard through residency and you have learned virtually everything you need to know to care for a patient... except how to set up a podiatry practice. You've heard about podiatry house calls and have decided that that practice model might be right for you.

Regardless of which of these 2 groups you may fall into, the chances are good that a podiatry housecalls practice might be the best setup for you.

I have created this blog in order to help others learn how to set up a low-cost, high profit practice that has the potential to generate significantly more income than the average podiatry practice while working a fraction of the hours.

In the coming posts, you'll learn all the details of this practice model. If you are thinking about setting up a podiatry house calls practice and have a question, you can simply post it as comment. I will post and answer as a reply as quickly as I can.


Dr. Christopher Segler is a podiatrist who previously practiced podiatry in a conventional insurance-based high-volume surgical podiatry practice, which he started from scratch straight out of residency. He became increasingly frustrated with the long wait for payments from insurance companies, insurance denials, massive overhead, and administrative hassles of running a conventional office-based podiatry practice. He then converted his practice into a low overhead, high profit house calls based podiatry practice. As a result, he sees approximately 1/9 of the patients he used to see while significantly increasing his income. Today it is his mission to help other young practitioners and frustrated long-term podiatry practitioners develop the freedom of lifestyle that allows them to have significantly higher income with more fulfilling patient physician interactions in a much more profitable practice model.