Believe it or not, the at-home doctor’s visit is not only returning, but the industry appears to be growing. In a world where patients spend more time in a waiting room than they do in front of the doctor, the in-home care model is a breath of fresh air. So why is the trend gaining traction? To understand the present, we need to look at the past.
Watch any black-and-white movie and you’ll see physicians caring for a patient who is enjoying the comfort or his or her own bed. The Clinics in Geriatric Medicine journal estimates that in the 1930s, house calls accounted for roughly 40 percent of all physician-patient encounters. However, that number dropped to 10 percent by the 1950s and practically vanished entirely during the 1980s.
The journal cites several reasons that house calls started to fade, such as:
- Improvements in technology: Facilities received new tools for diagnosing and treating illnesses. This got people out of their homes and into an office.
- Insurance coverage: Private insurance bucked house calls from policies, making the house call too expensive for many.
- Financial incentives: Physicians could see twice the number of patients in an office setting as they could traveling from home to home.
As Clinics in Geriatric Medicine points out, other countries have sustained home visits because these constraints are not present. For example, in Britain, which has subsidized health care, doctors make up to 10 times more house calls than physicians in the United States do.
However, house calls now are making a comeback in this country, as those limiting factors are slowly disappearing.
Medicare Resuscitates the House Call
Medicare amended its billing procedures in 1998, allowing for physicians to bill for home visits. A study from The National Institutes of Health note that doctors made roughly 478,000 house calls to Medicare beneficiaries in 2000 and more than twice that – 995,294 – in 2006.
The NIH study also found that as the number of in-home care visits rose, the number of doctors providing them declined. In other words, a smaller number of doctors took on a larger number of home visits. The findings indicate that the doctors who made home visits tended to be in solo practices.
Money and Technology
But can Medicare changes take all the credit for the rise in home visits? Of course not. Research has shown that the practice is actually cost-effective. Take, for example, an older man who is homebound due to a disability. He can continue to receive necessary check-ups without the hassle – and sometimes, risky exposure – of going to a hospital or doctor’s office, which can cause costly complications.
The very nature of an in-home visit has changed dramatically since the time it was last popular decades ago. For example, the little black bag a physician would carry into a 1950s perhaps held a few basic tools. Today’s black bag is equipped with a smartphone, portable lab kit, IV medications and even an EKG machine. In other words, physicians can essentially bring the hospital to the patient.
From the Doctor’s Perspective
The increase in house calls illustrates that physicians are seeing the benefit to providing patients with more personalized care. Instead of a patient getting rotated through a practice and seeing whichever doctor is available for a same-day or next-day appointment, house calls enable a one-on-one relationship between doctor and patient, which can reduce common mistakes attributed to medical records getting bounced from office to office.
Additionally, a home visit allows a physician to see the environment in which a patient lives. That kind of insight permits a doctor to provide even more comprehensive care, as he or she may be able to identify unhealthy living situations that should be addressed.
Private medicine, which has been around since the 1990s, includes this kind of personalized care into their practices. With longer, more attentive patient visits in a secure environment, home visits may well be both the past and future of medicine.