House Calls Are Making a Reappearance

Physician's Money Digest, December31 2004, Volume 11, Issue 24

Spurred in large part by an increase in how muchMedicare pays physicians for making housecalls, the number of house calls that the nation'ssenior health program has paid for jumpedfrom 195,000 in 1996 to 1.5 million in 2001, accordingto the Centers for Medicare and Medicaid Services(CMS). This roughly coincides with CMS' decision toincrease the reimbursement for house calls by 50% in1998, after years of negotiation with the AmericanAcademy of Home Care Physicians (www.aahcp.org).

A doctor who makes a house call now can be paid asmuch as 45% more than for an office appointment. Thehigher Medicare payments have also led several hospitalsto add house call doctors to their staffs. The rapidrise in the number of home visits, however, has somehouse call advocates concerned that the increase in reimbursementcosts may catch the attention of the beancounters at CMS, which could result in lower payments.

According to some estimates, about 2 millionAmericans are confined to their homes because of chronicillness. And house call doctors are now able to meettheir patients' health care needs through a wide array oftechnologically advanced medical treatments and procedures(eg, electrocardiograms, x-rays, and ultrasounds).

The Old Days

Up until the late 1950s, more than half of all doctor-patient contacts were at home. By the time Medicareentered the health care picture in 1966, however, doctorshad virtually given up making house calls. At that time,Medicare reimbursements were set so low that housecalls were close to being pro bono, and most modernmedical technology tools were in the doctor's office.

Today's house call doctor, however, has a far morepowerful set of tools than what was in the classic littleblack bag of the past. Medical professionals say thathouse call doctors can now provide 21st-century medicinein the home. Treating patients at home also allowsthe doctor to spend more time with patients than they doin the medical office. House call doctors may see seven to10 patients a day, compared with the 20 or 30 a day thata doctor may see in a clinic, office, or hospital setting.

Into the Niche

As Medicare payments have increased, a bevy of for-profitcompanies that hire house call doctors to providein-home medical care have sprung up. Such operationsare actively recruiting doctors, targeting specialties likeinternal medicine and geriatrics. Doctors who work forthese companies say the chance to spend more time withpatients is a motivator. Also, house call doctors avoidhassles with HMOs and case managers, and medicalmalpractice issues are minimal.

Although a doctor can incorporate in-home medicalvisits into an existing practice, some are going into housecalls full-time, citing benefits like the ability to workfewer hours a week and schedule free time more effectively,while maintaining income levels.