House calls stage a modest comeback, offering some patients easier access to care

The last thing you want to do when sick is be surrounded by hundreds of other sickly people.

Enter the house call.

“House calls go back to the origins of medicine, but in many ways I think this is the next generation,” Dr. Patrick Conway, chief medical officer of the Centers for Medicare and Medicaid Innovation, recently told Kaiser Health News.

Dr. Conway is overseeing a program called “Independence at Home,” which is based on the days when doctors readily showed up at patients’ home to examine their condition.

House calls can be an effective and preferred way of treating ailing patients in the comfort of their own home. Back in the 1930s, an estimated 40 percent of opatient encounters occurred in the home. But by 1950, the trend of house calls was waning because of the centralization of medicine and advances in equipment.

The practice is making a modest comeback though.

The number of house calls increased from 1.4 million visits in 1999 to 2.3 million in 2009, according to Medicare Part B billing data. Because America’s population is slated to age beyond 65 years by 2030, the American Academy of Family Physicians expects the demand for house calls to rise.

The benefits of personalized care

Physicians who make house calls don’t see as many patients as possible in a day, which is why patient appointments can be longer. Health issues can be more fully discussed and understood. From the patient’s point of view, this can mean improved quality of care.

According to the University of Michigan School of Public Health, patients tend to feel happier about their medical care when they have shorter waiting times and longer consultation times with their doctors.

Having a doctor come into their home, conduct medical examinations, and provide medical care can also make patients feel like they’re getting better value for their health care dollars. More access to a physician’s services can be very appealing, particularly for patients suffering from chronic diseases.

According to findings from a study conducted in 2014 and published in the Journal of the American Geriatrics Society, Medicare costs among 722 elderly patients in a house call program averaged $8,477 per person over two years, which was 17 percetn lower than the control group that didn't receive house calls. The house call group also had 9 percent fewer hospitalizations, 10 percent fewer emergency department visits, and saw specialists 23 percent less.

Serious drawbacks to model

Despite the benefits, there are logistical considerations that physicians need to think about. Not all medical issues can be addressed at a patient’s home.

And physicians who make house calls take a hit in pay, since traveling to multiple visits in a day could mean attending to fewer patients. Doctors who visit patients at home aren’t able to squeeze in as many patients as doctors who treat patients at their clinics can. And, while most insurance companies do reimburse for house calls, they do so only if there is a genuine medical reason the patient can’t visit an office instead.

For physicians, such calls can create new demands on their time. Several house call service providers offer 24-hour access to patients.

While trends seem to point towards an increase in such home-based services, such challenges also impose real limits to the prevalence of house calls as a model for delivering care.

[Photo by Day Donaldson via Flickr.]