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Wednesday Jan 28, 2015

House Calls Improve Care, Lower Costs

Although demand for the service is building, the number of family physicians making house calls is shrinking. In a 2010 AAFP survey, 19 percent of Academy members said they made at least one house call a week. By 2013, the number had fallen to 13 percent, and only 3 percent of respondents reported making more than two house calls a week.

With a rapidly growing elderly population, will that trend ever reverse to meet demand? By 2030, the number of Americans age 65 and older will account for 20 percent of the U.S. population(www.cdc.gov). And by 2038, the nation's elderly population is expected to double to 72 million -- or roughly the current population of California, Florida and Illinois combined. Two-thirds of the people in this age group have multiple chronic conditions and likely would need regular health care visits, which they may have difficulty accessing.

The number of house calls to Medicare beneficiaries more than doubled from 2000 and 2006, despite the fact that the number of physicians making house calls declined during the same period.

In my rural community, there are few resources for assisted living, so house calls could be the difference between an elderly or disabled patient staying in his or her home or moving to a nursing home. A 30-minute house call also can save a patient's spouse or adult children from taking half a day off work to get a patient to my office.

Although it is coded differently than a traditional house call, I also visit my patients who are in nursing homes so they don't have to be loaded into a van, transported across town, unloaded and reloaded. Coming to the patient, in these instances, is easier for everyone.

And it isn't just an age issue. I've made house calls on patients recovering from major surgeries, car wrecks and other issues -- including terminal illness -- that would make it challenging for them to come to me.

Interestingly, as reimbursement for house calls has improved, the number of patients treated at home has increased dramatically(www.jabfm.org) even though the number of physicians making house calls has declined. Part of the explanation for this phenomenon is practices that specialize in house calls(newsok.com).

It's an intriguing business model with lower overhead. It also holds potential to lower health care costs by catching relatively small problems before they become crises and keeping patients with chronic conditions and mobility issues out of the ER. A pilot program(www.washingtonpost.com) created by the Patient Protection and Affordable Care Act is documenting how providing house calls can lower Medicare costs, and Medicare will share savings with participating practices.(onlinelibrary.wiley.com)

A study published last year(onlinelibrary.wiley.com) 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 subspecialists and 27 percent fewer stays in skilled nursing facilities.

Obviously, house calls are a service that not all family practices can provide. But for those who can, it is a way to improve care and outcomes and potentially increase revenue. It's also worth noting that if primary care physicians won't make house calls, other health care professionals(www.record-eagle.com) are willing to fill that void.

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 09:46AM Jan 28, 2015 by Beth Oller, M.D.

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