The return of the house call

WI_GBPThe idea of a doctor making a house call may seem too good to be true.

But some physicians deliver exactly that level of care to their patients.

Tom Zenner, a family medicine doctor for Bellin Health, is one of the physicians honoring the tradition. He said he’s “semi-retired,” but still sees about 15 patients a week, mostly seniors, in their homes or assisted living centers.

The Kewaunee doctor has been making the visits for about 32 years. When he started, “it just seemed like the right thing to do,” Zenner said.

The practice may be unique, but it saves money and allows health care providers to get more information about their patients than they would have during an office visit. It allows physicians to monitor a patient’s environment, assessing a number of factors, including risk, nutrition, obstacles and barriers.

At-home patients save 19 percent more than inpatients, with “comparable or better” clinical outcomes, according to June 2012 study that examined Johns Hopkins University Schools’ at-home care.

“It’s invaluable to be here,” Zenner said. “You can see, the plants are kept up, her house is neat as a pin, her clothes are clean. It all tells a story.”

Getting to the doctor’s office also is a challenge for some patients, Zenner said. If they don’t drive, they must rely on family or public transportation, which can be inconvenient and a significant expense.

Zenner has treated Mary Thor, 92, for several years. After she returned to her home after a stay in assisted living, he offered to see her in her home.

“It’s easy for me to do,” he said. “It’s primarily a convenience issue, but it solves some problems, eliminating the fear she’ll slip and fall. Now she’s got independence.”

Zenner also is able to communicate about Thor’s condition to other doctors who are treating her. He can draw blood and monitor her medications for them during his visits.

If a person receives care at home, it makes it less likely he or she will be readmitted to hospitals, said Melanie Tiedt, director of Home Care and Hospice for Aurora BayCare Medical Center.

“Patients don’t want to be readmitted, so we make sure we have the tools and resources (inside their homes) so they can manage independently,” Tiedt said. “Many times, what we leave in the home are instructions for patients to further reinforce what the physician has started in the clinic or the hospital. The patient is not necessarily going to live in a controlled environment, so we ascertain what they need to do at home to ascertain what they need to do to live well.”

Aurora and Bellin caregivers, including physicians and visiting nurses, each made almost 12,000 home visits last year.

The Bellin doctors who perform home visits do so voluntarily, said Amy Dettman, the hospital’s physician division vice president. But the program is expanding.

“In rural communities, it’s even more common,” Dettman said. “With less transportation services, it makes it so much harder for patients to get in. … In some cases, the physician isn’t interested. It varies by physician.”

Patients do better in their home environments, she said. While physicians see fewer patients in a day when they perform home visits, the benefits of at-home care create efficiencies overall.

“It’s less expensive overall to keep patient at home,” Dettman said. “The nursing home is more expensive, and the hospital is still more expensive.”

The procedures and treatments performed in the home, however, are not serious, said Dr. Neal Fischer, a regional medical director for Humana. Patients who receive house calls typically have serious chronic conditions; they’re not homebound, but leaving the house for a doctor’s visit “is not ideal,” he said.

“These are things that would be treated in a physician’s office, but these programs are not designed to recreate the ER, ICU … routine sorts of care, basic services, eye exams — things like that,” Fischer said. “It can be a godsend.”

Clinical personnel focus on situations people face after they’re discharged to ensure equipment is properly set up and functioning to minimize harm in at-home situations.

“We are working hard to reduce re-admittance,” Fischer said. “The readmission rate is something that Medicare … Washington has been closely looking at. In the traditional Medicare program, it’s something under tremendous scrutiny. Sometimes re-admissions occur appropriately and not all re-admissions can be prevented. But good care after discharge can reduce the burden of illness.”

Admissions can cost “many thousands of dollars,” Fischer said, and the cost associated may result in patients not seeking treatment as often as they may need.

“The real savings is good care management, to allow people to stay in their homes and not get admitted.”

—published in Green Bay Press-Gazette, Feb. 2013

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