All things old can be new again. In an opinion column in yesterday's Boston Globe, Dr. Elizabeth Kass, medical director of Urban Medical, and Dr. Mark Zeidel, chief of medicine at Beth Israel Deaconess Medical Center, suggested that that the long-lost medical house call is returning to our society and, in fact, may become a cost-effective way to assist loved ones who are ailing and their families who are dealing with the complex healthcare system.
In the program described by Dr. Kass and Dr. Zeidel, 500 elderly, disabled, and chronically ill people who are participating in a special primary care program receive monthly visits from clinicians, who often are nurse practitioners. The medical professional who visits the patient utilizes a laptop computer to connect with the physician, hospital, and support services.
This type of program may lead to benefits both medically and economically. Dr. Kass and Dr. Zeidel wrote, "A recent analysis looked at 90 frail elderly Urban Medical patients who are enrolled in the Massachusetts Senior Care Options Program. Their total healthcare costs were 40 percent lower than the cost of care for similar patients not receiving house calls. (Actual costs for the study subjects were compared to Medicare and Medicaid combined premiums, which represent the expected cost of care for patients with similar conditions.) Most of the savings came about because of hospitalizations that were prevented and nursing home placements that were deferred."
The doctors added, "The team approach is more expensive and more resource-rich than the traditional doctor-centric primary care practice. House calls alone cost about $150, or twice as much as office visits, which is why they nearly disappeared in the 1960s in the face of shrinking reimbursements. But the Massachusetts Senior Care Option experience suggests that this additional cost is more than offset when house calls are a part of a system that assures continuous management of all healthcare needs, at all times, through all settings. This model contrasts sharply with the fragmentation and depersonalization of our prevailing healthcare system."
There are other models that are being explored that take a similar approach. Back in August 2007, I wrote a sharepost about Johns Hopkins Bloomberg School of Public Health's two-year trial called "Guided Care" that provides a registered nurse as a facilitator between doctors, the loved one, and the family. The program's website reports, "In the Guided Care teams, a specially prepared registered nurse works closely with 2-5 primary care physicians in caring for their chronically ill older patients. For each Guided Care patient, the nurse conducts an in-home assessment, develops an evidence-based ‘care guide' to address the chronic problems, monitors the patient proactively, coaches the patient in self-management, coordinates the efforts of all health care providers, smoothes the patient's transitions between sites of care, facilitates access to community resources, and educates and supports the family caregivers."
