Doctors are bringing back the house call

The program makes doctor visits for the elderly cheaper and easier.
WASHINGTON (AP) -- Ruth Mitchell grins widely as her doctor walks into her kitchen and spots the recovering stroke victim faithfully following his prescription -- raisin bran for breakfast.
"That's great," exclaims Dr. Eric De Jonge as he wheels in his black bag, loaded not just with stethoscopes and shots but with miniature modern gadgets usually seen only in hospitals: a beeper-like pulse oximeter to measure the oxygen in Mitchell's blood, analyzers for on-the-spot blood testing and a plate-sized EKG machine, among other things.
De Jonge and a team of geriatricians and nurse-practitioners are bringing old-fashioned house calls with a modern twist to impoverished streets in the nation's capital -- targeting the hardest-to-treat Medicare patients, those with multiple chronic illnesses who can't or won't visit a doctor until they're so sick they show up at emergency rooms.
De Jonge's records show regular health care in these patients' homes cuts expensive hospital stays and helps stroke victims like Mitchell stay out of even more costly nursing homes.
Just the beginning
It's a small but fledgling movement: Roughly 700 doctors around the country offer at least some house calls, says the American Academy of Home Care Physicians. They range from businesses that offer the convenience for an extra fee to doctors who say the huge needs of frail seniors can't be met during a 20-minute office visit, even if homebound patients could get there.
Such elder care is still rare; Medicare pays for about 1.5 million house calls a year. More rare are comprehensive programs like De Jonge's that bring special services -- speech therapists, social workers to arrange Medicaid-funded aid, even portable X-rays and echocardiograms -- into the living room any time of day.
"It's difficult financially for physicians to do this, and many have never been trained" to do house calls, says AAHC executive director Constance Row.
But De Jonge and Dr. George Taler contend the "Medical House Call" program they co-founded at Washington Hospital Center shows home care can be financially doable, even cost-saving, by better treating the 5 percent of Medicare patients who account for more than half the government program's spending.
House visits cheaper
Preventing just one emergency-room visit, usually $2,000, can offset a year of Medicare-paid house calls for that patient, typically 16 house calls at $100 apiece, Taler says. When patients need hospitalization, they're admitted to the geriatrics wing, where De Jonge and Taler also care for inpatients and records of the 410 enrolled patients show the program has cut the average hospital stay by almost three days.
It's not easy. Despite no rent and a hospital's backing, De Jonge and Taler needed major grants to start the program in 1999, and it took three years to break even. But they're now training other health workers to copy the system; one has begun in Cincinnati, and another starts this month in Harlem, N.Y.
"This is for people who have a passion for the frail elderly," says De Jonge, who calls the long-term relationships formed during his hourlong house calls more emotionally fulfilling than office-based medicine.
More than treating an ailment at a time, going into patients' homes lets health workers see preventable problems they'd otherwise never know about and teach caregivers to cope.