Once upon a time, house calls used to be the norm, with up to 40 percent of patients receiving in home health care. However, as medicine became more centralized and advancements in medical device technology became more complex and more frequent, the house call doctor started to go away, along with his iconic black bag.
In order to receive health care, people must now make their way to the nearest clinic, pharmacy, hospital or doctor’s office, which is convenient for health care providers but not so convenient for the sick and elderly. Fortunately, it appears as if that’s all about to change again, thanks to even more advanced technology, an aging population and payment models that reward health care providers who are able to reduce the amount of hospital admissions.
If you’re nostalgic for the good old days when you could rest in bed with a fever and know that your primary care doctor was just a phone call away, your trip down memory lane may become a reality. According to several news reports, from sources including Medical Economics, US News and the Chicago Tribute, medical billing data reveals a drastic spike in house calls over a ten-year span. According to the data, there were approximately 1.4 million in home visits in 1999, but that number nearly doubled to 2.3 million in 2009. Part of the reason, these reports suggest, is the growing population of graying individuals in America, which is expected to reach 70 million by 2030.
While the increasing number of seniors is a testament to the nation’s medical advancements, it poses a worrisome prospect to the American Academy of Family Physicians. The academy fears that the nation’s current long-term care and assisted living infrastructure is not equipped to handle 70 million-plus individuals who are apt to require some sort of ongoing health care. Its solution? To bring the house call doctor back.
In home health care is nothing new. In fact, what is new is inpatient care (vists to the doctor's office). Doctors have been making house calls for centuries, while it wasn’t until the 1950s that primary care physicians started requiring the majority of their patients to come to them as opposed to the other way around. By the 1980s, approximately 1 percent only of patient visits happened in the home, a rate that has remained more or less the same over the years. However, the recent bump in outpatient visits is promising and proof that the old way of doing things may not be so outdated after all.
Though inpatient care is and always will be needed, outpatient care comes with numerous benefits for both doctor and patient. For patients, the appeal of in home health care is the convenience and personalization of their care. Back when house calls were the norm, going to the patient was the decent thing to do. Patients didn’t have to go out into the world when they were sick, only to sit in waiting rooms with other sick individuals just to be told by the doctor—when she was finally ready to see them—that the key to recovery was a day in bed. Rather, they could stay in bed and receive the rest and relaxation they needed until the doctor came to them, which is what people will be able to do once more when house calls come back.
Moreover, doctors’ offices these days are packed with patients just waiting to be seen. This puts a significant amount of pressure on health care providers to see as many patients as possible in any given workday. Not only does this result in a less personalized patient experience, but it can also lead to mismanagement of symptoms and conditions. House visits provide for a level of personalization that is foreign to most people today. Instead of rushing patients in and out of the exam room, in-home primary care doctors can really take their time with patients, thoroughly assess their conditions and come up with treatment plans that work for the individual.
For doctors, house calls may provide for more positive patient interactions and outcomes. In making house calls, physicians can see how patients live, which a growing body of research suggests is paramount in devising effective treatment plans. For instance, if a patient never seems to get better despite medical recommendations, a primary care doctor who doesn’t make house visits may be at a loss as to what to do. However, if said physician were to go to the patient’s home and discover that it is infested with mold and located within a zone that has been affected by a sewage leak, he may be able to more accurately diagnose the patient’s condition and therefore provide more helpful recommendations for treatment and lifestyle changes.
In addition to being more personable, convenient and effective, the outpatient model can be more cost-efficient for everyone. It can also significantly lessen the number of hospital and ER visits, which costs the U.S. millions in tax dollars each year. On the other hand, it can reduce the number of nursing home admissions, which can save patients and their families thousands of dollars annually. That’s just the tip of the iceberg, and if it were to become the norm, a house call medical model could end up reducing the health care cost in the U.S. drastically.
Of course, as with all major reforms, there are many hurdles the industry must overcome to bring the house call back for good. In addition to having to revise the insurance infrastructure, the nation would also need to hire more doctors, as the more house calls a physician makes, the less patients he or she would be able to see. It’s also important to note that not all ailments could be treated via in-home visits either. Inpatient centers would still be a necessity, as some conditions are best handled with round-the-clock care and advanced medical equipment.
That said, in home health care is certainly making a comeback. It may prove to be the next big revolution of one of the nation’s largest infrastructures.