Why and how to find a doctor who does in-home visits…

The image of a doctor visiting sick patients at home, black bag in hand, is no longer a part of our past.

What’s new: Advances in portable medical equipment, a rapidly aging population and increased payments from Medicare for in-home doctor visits mean that house calls are back. In fact, the number of house calls made to Medicare patients more than doubled in recent years, and private insurers are beginning to cover them as well.

To find out more about the recent upswing in house calls and how they can benefit you, Bottom Line/Health spoke with Thomas Cornwell, MD, a national leader in home-care medicine who has made 31,000 in-home visits throughout his career.  

WHY THE COMEBACK?

Until recently, most major tests, like X-rays and ultrasounds, required a visit to a hospital or other medical facility. Now, technology makes possible diagnostic and therapeutic equipment that’s portable and accurate. Even a chest X-ray can be done in the comfort of the home. And house-call physicians currently have an arsenal of tools that they can use on the road—such as an ultrasound machine that fits in a pocket…a smartphone case that turns into an EKG machine…and an app for checking drug interactions.

Another driving factor: Most older adults would prefer to remain in their homes as they age and avoid expensive nursing homes. For many, this would not be possible without house calls.

What’s more: Studies have shown that doctors visiting patients in the home reduce hospital admission rates, readmission rates and overall costs. In fact, a recent study of Medicare patients found that those cared for at home had 17% lower health-care costs.   

The types of doctors most likely to make house calls include family physicians, internists, geriatricians and palliative-care doctors.  

THE MANY BENEFITS

Some patients are too sick to come into the doctor’s office but don’t need to go to an emergency room. Or they simply refuse to go to the doctor’s office…or don’t have anyone to take them.

Additionally, house calls are typically much longer than the usual office doctor visit. By going into the home, the doctor can assess much more than the current health issue affecting a patient. If the patient is frail, the need for in-home medical equipment, such as grab bars in a shower or bath, can be identified. Plus, safety risks like electrical cords or rugs can be pointed out to help prevent falls.  

Patients are encouraged to bring all of their medicines to a doctor appointment, but this is not always done, and often a drug or supplement is forgotten. A home visit is more likely to uncover all the prescriptions and supplements that are being taken. And by investigating other factors like diet and living conditions, a physician can better treat chronic conditions, such as diabetes or heart disease, or determine if the patient should be getting additional at-home assistance.

Finally, by remaining in their homes for medical care, patients are not exposed to the viruses and bacteria common in doctors’ offices. This is particularly helpful for those who have weakened immunity.

WHO SHOULD CONSIDER HOUSE CALLS

Frail older patients. For older patients who have difficulty getting out of the house, a home visit can be a literal lifesaver. Home-based primary care for frail older patients can help delay institutionalization or admission to the hospital and allow physicians to assess the quality of help caregivers are able to provide. For patients who are terminally ill, home visits provide palliative care and reduce the chances of dying in a hospital.

Patients who have certain disorders/­diseases. Among patients of all ages, house calls are extremely helpful for those who suffer from neuromuscular diseases like muscular dystrophy, Lou Gehrig’s disease or paralysis. With these conditions, getting to an appointment can be an arduous task, and home visits keep the doctor up-to-date on the patient’s needs. 

OTHER HOUSE-CALL OPTIONS

Some doctors’ offices now offer medical concierge services (the patient pays an annual fee or retainer to a primary care doctor). These services may include house calls. Costs range from less than $100 to several thousand dollars a year. Some employers also offer home visits as part of their employee insurance.

HOW TO ARRANGE A HOUSE CALL

For Medicare recipients and many with private insurance, there needs to be a medically necessary reason for the house call. The patient must also find it physically difficult to leave his/her home in order for Medicare or private insurance to cover some portion of the visit. Medical concierge services may not have this requirement.

To find a doctor who makes house calls: First, check with your primary care doctor to see if he can provide this service or give you a referral. You can also go to the website of the American Academy of Home Care Medicine, AAHCM.org, and click on “Locate a Provider.”

GETTING THE MOST OUT OF YOUR HOUSE CALL

The length of a house call depends on the patient’s specific needs and whether it’s a first-time visit or a follow-up. How to prepare…

As with any doctor appointment, write down all your questions and concerns beforehand.

Before the doctor arrives, arrange all of your prescription medications, over-the-counter medications and supplements in one place so that they can be reviewed by the doctor.

Make sure any family members who help out with your care are present so the doctor can get an accurate picture of the home environment.

Also: Don’t be afraid to reach out to your doctor between visits. Doing so, even if the problem seems minor, such as a lingering cough, may prevent an unnecessary ER visit or hospitalization down the road.