As U.S. Population Ages, Doctor House Calls Are Making Comeback
By Dr. James Palermo // October 9, 2015
HOME-BASED CARE IMPROVES OUTCOMES, LOWERS COSTS
Although still relatively uncommon, physician house calls for a specific healthcare demographic are making a comeback because of logistics and economics.
The concept of a doctor visiting a patient at home rather than a patient going to a doctor is hardly revolutionary.
According to a Clinics in Geriatric Medicine article, in 1930 about 40 percent of doctor-patient interactions were through house calls, but by 1980, the rate was down to 1 percent.
More recently, according to the American Academy of Family Physicians, only 13 percent of family physicians surveyed made regular house calls in 2013, and only 3 percent made more than two per week.
Traditional visiting-nurse services send clinicians to patient’s homes in the few weeks after they are discharged from the hospital—but increasingly, primary care providers are making regular house call visits to the chronically ill and infirm elderly with a goal to prevent costly emergency room visits, hospital admissions, and long term facility stays.
House calls can be expensive, but may end up costing less in the long-run, research suggests.
A 2014 study published in the Journal of the American Geriatrics Society compared the Medicare costs and outcomes of more than 700 patients enrolled in a house call program to a control group of more than 2,100 Medicare patients.
Patients in the house call group had 17 percent lower health care costs during a two-year period.
They also had 9 percent fewer hospitalizations, 20 percent fewer emergency department visits, 23 percent fewer visits to sub-specialists and 27 percent fewer stays in skilled nursing facilities.
A similar study in the same journal also suggests such patients have higher patient satisfaction.
The Center for Medicare and Medicaid (CMS) is also exploring the model through a pilot project called Independence at Home, which includes 20 medical practices across the country providing home-based care to more than 8,400 patients. The program targets high-risk, high-cost Medicare patients who have large gaps in care coordination and many hospital admissions per year.
In June, CMS released the results of the pilot program showing a savings of more than $25 million in the first year through lower admissions, readmissions, and ED visits.
Program providers that successfully reduced costs by at least 5 percent less than their spending targets were awarded $11.7 million in incentive payments via a shared-savings model, which makes the model more economically feasible for physicians to make a living and expand across the nation.
Many seniors are not receiving regular care simply because they are unable to leave home.
With research consistently showing that house calls improve care and lower costs, and a rapidly growing elderly population, 60 percent of which have multiple chronic healthcare conditions and likely would need regular health care visits, which they may have difficulty accessing, home-based primary care will likely play a more significant role in healthcare delivery in the future.