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Resurgence of House Calls Bridging Care for Vulnerable Adults

According to recent reports, home-based primary care is making a comeback. The revolutionary Primary Cares Initiative recently announced by the Centers for Medicare and Medicaid (CMS) aims to bring comprehensive care to the patients who are homebound. This is a welcome development for vulnerable older adults with chronic conditions who are unable to visit a physician’s office. Home-based primary care teams comprise specialists from internal medicine, family practice, geriatrics, and more, as well as nurse practitioners, physician assistants, social workers, and practice managers. Medical transcription outsourcing companies in the US are well-equipped to meet the anticipated increase in demand for primary care documentation.

Resurgence of House Calls Bridging Care for Vulnerable Adults

House calls were common half a century ago. The numbers of physicians seeing patients in their homes dwindled over the years, but these interactions are increasing, say recent reports. However, there is immense potential for expanding home-based primary care.

According to a 2015 article in JAMA Internal Medicine, up to 2 million Medicare patients age 65 or older were completely or mostly homebound in 2011. An additional 2 million people have severe chronic conditions and functional problems, which makes it difficult for them to access care outside the home.

The study found that only about 12% of homebound patients receive primary care in their homes. The lead author Katherine Ornstein, PhD, MPH, noted that the number of homebound patients is larger than the nation’s nursing home population (www.news.aamc.org).

Since many of these patients have multiple comorbidities, they often rely on the emergency room when they do not have access to primary care. Emergency department (ED) visits tend turn into lengthy hospital admissions. CDC statistics show that in 2016, up to 12.6 million ED visits resulted in hospital admission.

With the shift to the value-based healthcare system, home-based primary care offers the optimal solution to bring care to the growing population of older adults and those living with chronic diseases. House calls are an excellent way to optimize care for needy patients while significantly reducing treatment costs.  The key benefits of hone-based primary care are:

  • Viable option for homebound and functionally limited patients with complex care needs
  • Allows providers to teach patients how to manage chronic conditions like diabetes
  • Supports interdisciplinary care
  • Patients treated at home recover well, on par with patients admitted to the hospital
  • Improves patient compliance and satisfaction
  • Decreases hospitalization rates and saves costs
  • Integrates behavioral care and social supports into primary care
  • Promotes rapid response to urgent and acute care needs
  • Offers palliative care
  • Supports family members and caregivers

Home-based primary care offers the benefits of personalized care as well as modern technology. Providers who make house calls use cutting-edge technology, including lab tests, EKGs, X-rays, ultrasounds, IVs, and more, to diagnose and treat patients. Consistent comprehensive care can help prevent medical complications, avoid hospitalization, and allow patients to age in place (www.todaysgeriatricmedicine.com).

A recent Pacific Standard report describes how Mount Sinai hospital was among the first to start a house call delivery program in New York City. The program involves community agencies, such as visiting nursing associations as well as a network of nurses, social workers, and others, to predominantly treat persons with functional disabilities and multiple health conditions. It currently covers 1,800 homebound patients in Manhattan over the age of 18 who have difficulty accessing care outside the home. The Mount Sinai Visiting Doctors program is widely acclaimed as an effective option to treat the sickest patients.

In 2012, CMS launched the Independence at Home demonstration project to test the efficacy of house calls. The participating house-call programs saved about $3,070 per patient, and reduced Medicare costs by 30 percent, by cutting unnecessary hospitalizations. House calls also improved care quality and patient satisfaction. Participants in Independence at Home (IAH) included the MedStar House Call Program Boston Medical Center, Christiana Care Health Services, University of Pennsylvania Health System, and Virginia Commonwealth University.

The success of house call medicine depends on many factors. According to Dr. Linda DeCherrie, clinical director of Mount Sinai at Home, identifying the patient’s goals for care is crucial (www.psmag.com). Patients with chronic illness would benefit from a combination of primary care and palliative care. Meeting these goals is important.

Another factor is having good medical staff perform the home visit. Providers need to be educated to deliver home-based primary careas the experience of seeing patients at home is significantly different than in a clinical setting.

Providers of home-based primary care also need to be paid for their services. The success of house call medicine will also depend on attracting a larger workforce and providing the necessary training (www.news.aamc.org). According to a 2016 Health Affairs study, rural regions had only limited accessto home based primary care due to a shortage of trained providers.

The new CMS Primary Cares initiative is expected to open up new opportunities expanding home-based primary care. In a press release dated May 9, 2019, Dr. Thomas Cornwell, a practicing home-based primary care physician and Founder and CEO of the Home Centered Care Institute (HCCI), noted that the CMS Primary Cares initiative offers “a real chance of attracting more providers to the field – creating universal access to best practice house call programs, making home-based primary care the national standard for treating medically complex patients who are better cared for in the home.”

As the Primary Cares Initiative increases patient access to advanced primary care services, physicians’ documentation tasks will also increase. Medical transcription outsourcing is a practical option to meet these requirements.

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