As pressure mounts for physicians to manage patients' chronic conditions out of the hospital, the house call has re-emerged as a way to complement office-based care. Unlike doctors' black bags of the 1950s, however, today's tools of the trade rely heavily on health information technology.
For example, Timothy Lowney, D.O., a family physician who participates in a home-care pilot in Massachusetts, always totes his laptop to patient homes, from which he can access and write patient notes, e-prescribe medications, order x-rays and track patients' overall care, according to an article in the Patriot Ledger.
These efficiencies are valuable on many fronts: They offest the drive time between visits, enhance care coordination and help patients feel unrushed at a time when primary care physicians are stretched thinner than ever.
"You can understand each other a lot more than in a doctor's office," James Sullivan, one of Lowney's home-visit patients, told the newspaper. "They're in a hurry there." Sullivan is among the 200 or so at-home patients Lowney and a nurse practitioner visit as part of the program, which represents about a third of their practice. Almost all of the patients are on Medicare, and either have chronic health issues or need follow-up care after surgery or injury. Lowney works in conjunction with many of his home patients' regular doctors to keep these at-risk individuals out of the hospital.
While changes to insurance and Medicare payments have made calls like his financially workable, according to Lowney, a larger goal of the pilot is to prove the model improves patient health and saves money.
And although virtual house calls as a substitute for office-based care remains somewhat controversial, a program being tested in Houston has demonstrated their value in avoiding unnecessary trips to the emergency department (ED).
Houston firefighters carry tablets loaded with video-chat software with them on emergency calls, according to a post from NPR. In situations in which the firefighters, who are also cross-trained as emergency medical technicians and possibly advanced paramedics, believe a trip to the ED may be unwarranted, they connect the patient with a fire department physician for a second opinion.
Through this technology, known as Project Ethan, an acronym for Emergency TeleHealth and Navigation, patients and responders can answer the doctors' questions directly, while physicians can also see their patients' faces and reactions.
On one recent call, for example, Kenneth Margolis, M.D., was able to not just reassure a patient that an ED visit wasn't necessary, but he also scheduled her for an appointment at a nearby clinic the next morning, round-trip cab fare included.
Although the project costs more than $1 million a year to keep running, its leaders hope to save even more money long-term by preventing ambulances from being tied up with ED admissions more than necessary and by following up with patients to identify other issues that may lead to inappropriate calls to 911.