The academy includes doctors from medical centers that have house-call programs, as well as those in small practices. The organization is lobbying Congress for permission to bill Medicare and Medicaid using a Care Level-type model that includes monthly rates, rather than paying for each visit.

Dr. Henri Becker developed the model for Care Level in 1995, when he was the medical director of the Huntington Provider Group in Pasadena, Calif. Dr. Becker found he could cut repeat hospital admissions by treating the sickest patients at their homes, before their medical problems grew dire. In 2001, he teamed with Raouf Khalil, an entrepreneur who had sold a successful home-infusion business, to start the company.

Care Level has grown to about $65 million in annual revenue with 350 employees in California, Arizona, Pennsylvania, Texas and Florida. Mr. Khalil, the chief executive, would not disclose income amounts, but said the company was profitable. About 85 percent of its patients are in the Medicare trial, with the rest coming from commercial insurers.

Source: Handling House Calls in a Managed-Care World - New York Times

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