ACT Health Solutions – Ada Tapper, DNP, APRN, Owner
ACT Health Solutions is a house call practice based in Hillsborough County, FL, focused on delivering exceptional care to homebound patients. Founded in 2018 to provide transitional, chronic, and primary care services, ACT Health Solutions joined The Florida House Call Project as a Home-Centered Care Champion in 2020 and has participated in multiple specialized training initiatives aimed at raising awareness of home-based primary care (HBPC). In this interview, founder Dr. Ada Tapper, DNP, APRN, talks about the challenges and rewards of operating her practice.
Q: How would you describe your staffing model?
A: We have a consulting physician, two nurse practitioners, a registered nurse, and a medical assistant. We also have access to social workers through various home health agencies and consult with mobile specialists in fields such as podiatry, psychiatry, pain management, and others, who serve patients in their homes.
Q: What recent challenges has your practice faced and how have you overcome them?
A: One of the things we learned through COVID was that many of our patients do not have updated technology, and some are not as proficient with technology. After attempting video chats with a few patients, we found that we needed to visit them face-to-face, following CDC guidelines, to continue their care.
We are, though, struggling with attracting additional qualified staff members. Some of the difficulty is pandemic-related.
Another challenge is the current payment model. Medicare is a fee-for-service payment model focused on volume instead of value, which puts mobile providers at a disadvantage since the average number of patients seen daily ranges from five to 10 compared to 20 or 30 seen by clinic providers. We are, therefore, looking into other payment models, such as Direct Contracting Entity (DCE) and Primary Care First
Q: What makes you especially proud of your practice?
A: I am accessible to my patients. Sometimes I will answer the phone when a patient calls, and they’ll say they’re looking for Dr. Tapper. When I respond, “This is she,” they are surprised and will say, “No, I mean can I actually talk directly to her?” Then I say, “Yes, you are talking to me.” We have someone who answers the phone, but when it keeps ringing, I pick it up. We make sure everyone is taken care of and my patients feel they have fast and direct access to me.
Referrals from current patients also make me proud. I recently received a referral from a patient in an assisted living facility who walked me across the hall to introduce me to another resident. She told them, “This is my doctor and when I call her, she calls me back.
Q: What is unique about ACT Health Solutions’ approach to HBPC?
A: We treat relationships with our patients like partnerships because we want them to know they have ownership in their care. I want them to understand not just what I’m asking them to do, but why. Patients need to know the benefits of what’s being recommended as well as the potential consequences of not following the recommendations.
I also always tell patients the truth. One patient who was referring us to someone else commented, “Dr. Tapper is great, but if you want someone to sugarcoat something, she’s not the one.” Because at the end of the day, it’s about doing what is best for patients — even though they may not always agree. Once I needed to call 911 for a patient and she said if I did, she would fire me. I said, “Okay, that will be the best fire I’ve ever had,” and dialed 911. When she came back home and it was time for her next visit, I asked if I was welcome and she said, “Of course you are.”
Q: What goal is your practice most focused on right now?
A: I would like to add two additional nurse practitioners, which will help ACT Health Solutions grow more in the commercial insurance area. As I mentioned, we are also exploring other payment models and just recently signed a DCE contract.
Creating more awareness for HBPC is another ongoing focus. We’re out there, just like a lot of other practices, to take care of people who are unable to take care of themselves, unable to leave their homes. Often when you go into a home you hear people say, “I didn’t know this service was out there.” I want people to know we are out there to provide them with good, optimized care and to help them live their best possible life.
Q: Why do you love house calls?
A: I get to spend more time with patients in their environments, which enables me to provide comprehensive, holistic, individualized care. When you practice in an office, you only see one aspect of the patient and, many times, they only tell you what they want you to know. When you are in their home, you see what their world is and many times it’s more than what they want you to see. You can perform a more comprehensive medication reconciliation that includes supplements that patients often forget to mention. Or you discover the reason someone keeps falling is because all the seasonings are on the top shelf and they’re using a step stool to get them, or the area rugs don’t have any backing.
I structure visits around an opening, middle, and end. The first thing we do is catch up on all the peripheral things — how’s this, how’s so-and-so, how was the birthday party? Once I sang “Happy Birthday” to a patient, and her daughter started cheering and asked to record it so she could put it in a video.
From there, we get into patient-specific issues, then at the end of the call, we recap everything. I restate what we’ve gone over, what the patient needs to do, and ask if they have questions. I also remind the patient that if they start to experience serious problems, like shortness of breath, that I am to be their second call. In emergencies, 911 is always the first call.
House calls allow you to go into the home and take care of the whole patient. It feels different. You’re not looking at the clock, even though you must still manage your time. But you can get things done without making the patient feel like they’re being rushed.
Q: Which of the following best describes your practice setting?
A.: Home-Based Primary Care (HBPC), independent
Q: What types of services does your Practice provide?
A: Transitional Care Management|Longitudinal, CCM, HBPC|Telehealth
Q: What is your active patient census for HBPC — including all providers?
A: 90 patients
Q: On average, how many home visits are made each day by all providers in your practice?