Physicians House Calls

Physician House Calls

By: Amanda Baker

I am sure some people can remember when doctors actually went to their patients’ homes. Unfortunately, those days seem to have gone the way of rotary phones and good old-fashioned typewriters. In recent years, however, physician house calls have been making a comeback. What is a physician house call program? An interdisciplinary medical team, typically consisting of a physician and a nurse practitioner or physician assistant, cares for the patient in their home. They come to the patient’s home with portable diagnostic equipment and medical supplies, diagnose the patient’s health problems, design a treatment plan, provide medical care, arrange for any other needed health services and coordinate the patient’s medical care with other health and supportive service providers. The house call physicians will fulfills the role of the patient’s primary care physician or works with the existing primary care physician when the patient is no longer able to get to his or her doctor consistently.

Many patients who are elderly or are homebound have a difficult time being able to get out to the doctors and it also can cause patients who are ill with a weak immune system to pick up other viruses or illnesses easier than younger and healthy patients. A house call program makes it easier on the patients as well as safer for their health overall. "When you make home visits, you develop a very intimate relationship with your patients, and your work brings great relief to people in very difficult situations? Among other things, appropriately timed home visits can circumvent and prevent nursing home placements, visits to the ER, hospitalizations and all those expensive things Medicare is trying to avoid. Many older patients tend to have multiple, chronic health problems, and homebound seniors typically have the greatest burden of chronic disease of all. Most patients that are homebound it is due to disability resulting from strokes, lung or heart disease, hearing or vision loss, cognitive or emotional problems like dementia or depression, or, most often, a combination of several of these” (Alfred E. Stillman, MD, MACP, 2014).

In most cases the best way to get an assessment of what is needed is to directly go to the community and get the opinions of patients or family member that are struggling  with getting themselves or a loved one to their physicians and if they even have one. Most patients who are elderly and disabled will be Medicare recipients, so I would want to do a survey in certain areas to see what their opinion of a visiting physician would be beneficial and if they would be open to the ideal. Even if we get all the data stating that a house all physicians would be beneficial to a patient’s health, we still need to know if patients would want to have a physician come to their home. I would want to pull data from Medicare any other insurance companies on the impact of other home health care programs and how they have impacted a patient’s overall health, and also data from hospitals regarding a percentage of elderly and disabled patients who were hospitalized for issues that could have been resolved if treated sooner. From my experience working with a visiting doctor, we have seen several patients who have been hospitalized because there issues were left untreated because they were unable to get to their normal PCP due to medical issues or transportation, and there only options was to call an ambulance because they were having complications that couldn’t be ignored.  Most doctors who have an office will not go out of their way to see their patients at home which leaves patient to suffer and not get the help the need and some cases it has been fatal. A house call doctor helps improve elderly and or disabled patients overall health. Patients will be able to see the doctor when it is needed and are less likely to end up hospitalized.

The goal of the house call program is to ensure the best care and quality of life for the patient for as long as possible, in the setting that most patients prefer, which is in their own home. This program is designed to provide patients a personal relationship with a physician, continuity of care across time and place, and care where it is needed, for as long as it is needed. “The house call team will also try to provide the following services: Health assessment, diagnosis, and plan for treatment; Assessment of the home environment for factors that may contribute to  health and safety problems; Ongoing medical care; Care management and oversight, both within the patient’s home and across settings, home to hospital and rehab facility and back home again;  Coordination of health services with visiting nurses, medical specialists, hospital staff, hospice services and community agencies to improve the continuity of health and medical care and facilitate hospital admissions; and Support and education to patients and their families so they can make informed health care decisions” (Institute for the Future of Aging Services , 2008). House call physicians and nurses may also assist patients with identifying medical equipment needs, authorize and oversee durable medical equipment and home health providers, and conduct routine tests in the patient’s home, such as blood work, urinalyses, EKGs and x-rays so that a patient wo has a difficult time leaving their home can receive routine care in the privacy of their home unless the patient needs attention in a facility setting.

“Planning setup will consist of a two- to three-month process that will result in the development of a comprehensive business plan.  The participants in the planning process will include institutional leadership, selected practitioners and other key stakeholders that would be involved in any decision making.  The business plan will include a high-level market assessment, defined practice model, defined service areas, growth projections, staffing projections and a three-year financial plan.  The planning process is based on two- to three-hour working sessions, which are recommended to occur semi- monthly.   Project Planning Review and confirm all meeting dates, discuss different types of house call programs, review range of proposed house call services and define the proposed scope of services and service area (House Call Solutions , 2014),” we would need to go over many different relevant information to make sure everyone is involved and knows exactly what the games plan was.

“Confirm Approach and Technology Review the proposed House Call team approach and the team’s technology requirements” (House Call Solutions , 2014). I believe the best approach for this company would be to have everything done electronically, since we don’t need a very big office space due to patients being seen in their homes we can save on space and paperwork by installing Electronic Health Record system or as most of us call it today EHR. “EHRs are computerized systems that store and provide access to patient-specific clinical data.  Separate kinds of EHRs support hospitals and physician practices. There are many types of EHRs for physician practices; some require a server be physically located at the practice.  Others use servers that are based remotely and accessed via a private network or a secure internet connection.  A practice can acquire a “complete EHR, which includes all of the functionality required for certification in one software package.  Alternatively, a practice can assemble several certified EHR modules, which, when used together, provide full functionality” (American Medical Association, 2010). The less paperwork and hard copy patient charts the better. I would have each physician equipped with a tablet or smart phone that they would be able to input patient’s information and over a secure network that is approved through HIPAA for patient’s privacy and safety.