Apps make doctor house calls popular again, but cost-effectiveness in doubt

Startup companies are making it possible for patients to order a house call from a physician through a smartphone app. While the merger of old-fashioned house calls with new-fangled technology may be convenient for patients, it isn't very cost effective, according to a report in the Los Angeles Times.

The start-ups are cropping up in some major U.S. cities. There's Heal in Los Angeles, which serves several California counties, Pager in New York City and Mend in Dallas, according to the report.

But the reason physicians stopped making visits to patients' homes in the first place, may limit the return of the house call and create a challenge to further start-ups. "It's much more cost-effective to bring the patient to the doctor than the doctor to the patient. That's why we as a society moved away from house calls," Ateev Mehrotra, a Harvard health policy professor who studies innovations in medical care, told the Times.

That hasn't changed and with many parts of the country experiencing physician shortages, it doesn't make sense not to make the best use of doctors' time, some experts say.

For instance, physicians working for Heal, who are chauffeured by medical assistants, spend a lot of unproductive time in the car between house calls, as they may be traveling from one end of the Los Angeles region to the other visiting patients. Mehrotra says it's an inefficient process for doctors, as travel time is not cheap.

While in-home care for seniors and chronically-ill patients may make sense, some question the resources for what the Times describes as a novelty service for the wealthy, that is part of concierge medicine.

Advocates, however, say the house calls are keeping patients out of the emergency room. More than 60 percent of Heal's first-time users would have gone to the emergency room if they had not been able to schedule a house call, Renee Dua, M.D., the company's co-founder, told the newspaper.

Some worry that doctors may go on calls when a physician isn't really needed. Pager tries to address that issue by having people text message with a nurse who decides whether the patient needs an in-home visit or a videochat consultation.

The companies charge a flat-fee for a house call. Heal charges $99 for a house call, Mend charges $199 per visit, and Pager charges $50 to $200 depending on the type of visit, according to the Times.

One physician, who wrote about his experience as a house-call doctor, said his practice wasn't sustainable, and he predicted similar start-ups may struggle, as FiercePracticeManagement previously reported. The doctor said travel to appointments limited him to seeing no more than eight patents a day.

On the other hand, a House Calls program offered to recently discharged high-risk, frail and psychosocially comprised patients did help reduce preventable emergency room visits and hospital readmissions, according to a recent study. Boston Children's Hospital also has a program to provide house calls to a small group of pediatric patients who need intensive respiratory support, but a big challenge is funding.

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