Tampa Tribune reports that Medicare and private insurers are exploring house calls to save money
Published: June 10, 2011
Medicare, private insurers exploring house calls to save money
By Kevin Wiatrowski Standing at Kathy Larson's front door last week, Dr. James Condon offered up the latest health care innovation: a house call.
For the next hour, Condon sat across from Larson in her living room, chatting as he checked her vital signs, reviewed her prescriptions and gauged her overall well-being.
"Are we happy?" Larson asked as Condon performed his exam.
"So far," said Condon, a retired surgeon turned primary care doctor.
The house call is as old as medicine itself, but it has fallen out of favor in recent decades as doctors have grown more specialized and health care has moved to medical offices and hospitals.
Now Medicare and private insurers are turning back to house calls as a way of putting the brakes on escalating health-care costs, particularly for chronically ill people with complex health problems. With millions of Baby Boomers coming onto Medicare rolls in the near future, house-call doctors could play an important role in keeping a lid on costs, medical experts say.
Advocates say house calls eliminate the expensive, specialized transportation many patients with serious health problems need just to get to the doctor. House calls also help doctors catch health problems before they turn into costly trips to the emergency room or, in the worst case, life in a nursing home on the government's tab.
"By going to [patients], you make it much more possible for them to have the care that they need, when they need it," said Peter Boling, a geriatrician and instructor at the Medical College of Virginia, who literally wrote the book on making house calls – "The Physician's Role in Home Health Care" – in 1997.
"If we can keep them out of the hospital," Boling added. "We're probably also going to keep them out of the nursing home."
The ranks of house-call doctors are growing, responding to demand from patients weary of expensive, time-consuming treks to the doctor.
"There are so few providers to meet any definition of demand," said Constance Row, executive director of the American Academy of Home Care Physicians. "People open their practices, and they fill immediately."
An office visit works for people who can get around on their own, but people with complex, chronic illnesses – quadriplegics, stroke victims and others with limited mobility – often need costly specialized transportation to do the same thing.
If patients seek care when they're already ill, they can end up in the emergency room followed by a lengthy and expensive hospital stay.
"Every time we prevent an E.R. visit that's an unnecessary E.R. visit, you're saved the cost of an E.R. visit," said Jannifer Harper, vice president of medical operations at Blue Cross Blue Shield of Florida. "In the end, it's about providing the best health care for each patient."
Blue Cross plans to begin a house-call service in the Tampa Bay region this year. It will mirror similar services already running in the Orlando area and South Florida. Under the program, Blue Cross hires My Home Doctor, a consortium of house-call doctors, to treat complex patients with a history of hospital readmissions, Harper said.
Medicare will test the house-call approach on a limited basis in January. The Independence at Home program, created under last year's Affordable Care Act, will try to bring more doctors into the house-call field by offering them a piece of the money they save the government.
In 2009, Medicare spent $17.4 million on house calls in Florida, according to the most recent figures available. That represents a modest increase of about 5 percent, compared to 2008, even without efforts enticing more doctors to make house calls.
More money will be needed, though. Medicare's $17.4 million works out to a little more than $80 per patient - not enough to entice many doctors to make house calls their calling, Boling said.
The average complex patient costs Medicare $50,000 a year, so a savings of 15 to 25 percent can add up to big bucks pretty quickly for both doctors and the government, Boling said.
By getting more doctors to make house calls, the Independence at Home program, which Boling helped get into the health care law, could also solve problems for patients and insurers, Boling said, by:
• Avoiding the costly ambulance services needed to transport patients with complicated health issues to the hospital.
• Catching problems early to keep patients from showing up in emergency rooms.
• Keeping patients out of nursing homes, which account for the bulk of Medicaid spending.
New Port Richey-based Mobile Physician Services, which employs Condon, won't discuss the size of its client base. But Practice Operations Director Jeff Wacksman said the company plans to add a psychiatrist to its staff of seven doctors, nurse practitioners and physician's assistants. It will also add a mail-in pharmacy.
The company has patients spread across Hernando, Pasco, Pinellas and Hillsborough counties. Most are Medicare recipients, Wacksman said.
Staffers see seven or eight patients on their rounds. Each visit can take about an hour, compared to the average 15-minute office visit, Wacksman said.
Sitting in Larson's living room last week, Condon, a retired surgeon, traded jokes and stories with his patient. The two go way back: Condon removed Larson's gall bladder years ago when he worked at Community Hospital in New Port Richey.
Condon drew from his black satchel high-tech versions of the traditional doctor's tools to check Larson's blood-oxygen levels, blood pressure and temperature. At one point, he used a smart phone app to double-check the dosage of one of Larson's nine medications.
A stroke 10 years ago put Larson, 72, in a wheelchair. She lives with her 52-year-old son, Robert Eynard, who has his own health problems but is her main caregiver. Neither drives, so getting to a doctor can be a real chore.
The monthly visit from Condon or a nurse practitioner is a welcome change.
"This is the best thing since rye bread," Larson said.
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