The notion of a kindly doctor at your doorstep, black bag in hand and ready to treat your sore throat, seems as old-fashioned as a Model T. But for patients who are too sick or frail to make it to the doctor’s office, patient house calls are making a comeback in Colorado.
Just 10 years ago, the notion of doctors doing home health visits was all but extinct. “Almost all primary care physicians saw patients only in their offices. They might make an occasional house call for a frail elderly patient on their way home or something, but that was about it,” said Constance Row, executive director of the American Academy of Home Care Physicians (AAHCP) in Maryland.
Yet according to the AAHCP, between the years 2000 and 2009, doctor house calls for Medicare patients jumped by 53 percent.
Dr. Christopher Unrein of Lakewood is one of the 4,000 doctors now making house calls nationwide. “I enjoy what I do so much because I get to connect with people,” he said.
Demand is growing. Only a quarter of America’s homebound patients are lucky enough to have a doctor willing to treat them.
Row says the remainder may go without care because they can’t make it to the doctor’s office, and that raises the cost of their care in the long run. They may end up being rushed to the emergency room, and an expensive stay in the hospital.
In Colorado, the shortage is even more critical. Stephanie Hales, practice manager with the Colorado group House Call Physicians, estimates that there are currently fewer than 100 doctors making house calls in the state. The revival of medical professionals doing house calls started on the East and West coasts – and is just starting to come into play in Colorado.
“Two years ago, when we started our business, we had 40 patients,” Hales said. “Today, we have 800. And there are a number of physician groups now considering adding house calls.”Increasingly, physician’s assistants and nurse practitioners are making house calls as well.
In January, the federal government launched a three-year test program called “Independence at Home Demonstration,” which will research the effectiveness of treating thousands of chronically ill people at home.
The test is focused on patients in hospice care, the frail elderly and young people whose conditions range from mental illness to arthritis. The incentive for physicians? If they can prove they’re cutting hospital costs by treating patients at home, they would share in the savings. For example, at today’s rates, Medicare pays $150 for an in-home hospice visit – which is far less than the government would pay for a lengthy hospital stay.
Still, for many students fresh out of medical school, house calls are neither lucrative nor convenient.
“Physicians in an office can see 25 to 30 patients a day,” said Row. “Doctors making house calls only make about eight calls a day. The total income that is generated is woefully insufficient.”
Additionally, doctors are not paid for the time they’re in their cars, which can sometimes be an hour between house calls.
“The reality is, it’s down time,” said Dr. Unrein. “It’s wasted time from a purely economic perspective.”Unrein, who is also the medical director of the Hospice of St. John in Lakewood, is on a fixed salary and doesn’t worry about tallying up a high number of home patient visits. His average house call is 45 minutes, compared to 15 minutes or less he would spend with a patient in his office. Some days, he logs 100 miles in his SmartCar, making his rounds.
One of his patients is 64-year old Robert “Pep” Pepping, a Lakewood resident diagnosed with prostate cancer 13 years ago. The cancer has spread to his bones and he’s decided to spend his remaining time living at home, receiving medical care from Unrein and from his best friend, Steve.
“If I’d stayed in the hospital I’d be dead,” said Pepping. “Not getting the rest. People waking you up every half hour. To have the love that I have here; you can’t replace that.”
On a recent visit, Pepping and Unrein discussed medications at the kitchen table. The doctor checked Pepping’s heart and blood pressure. Unrein dispensed advice about dealing with the good days, and bad days. As he left, he told his patient he’d return soon. “Don’t make it too long,” Pepping said.
Unrein says his satisfaction comes from helping people like Pepping end their lives they way that they want to.
“I think this is the wave of the future, but to do it, we’re going to have to have a shift in thinking,” he said. “I call my approach high-touch, low-tech.”