The Doctor’s at the Door: How Medical House Calls Are Enabling Aging in Place

By Julie Sacks, President & Chief Executive Officer of the Home Centered Care Institute

Did you know that the medical “house call” still exists? Yes! It’s true! Throughout the country, medical providers including physicians, nurse practitioners, and physician assistants who specialize in home-based medical care (HBMC) are delivering care to homebound or home-limited patients in their home, or in the place they call “home.”

Often functioning as part of an interdisciplinary team managing both medical and non-medical needs (e.g., social factors, environmental needs), delivery of the modern-day house calls has proven to enhance quality of life for patients and caregivers, improve health outcomes, and reduce overall cost of care by preventing unnecessary emergency room visits and hospitalizations.

So, what is the modern-day house call?

The modern-day house call is technology-enable medical care provided in the home and includes the exact same care a patient would receive in the office of a primary healthcare provider.

Specifically, medical care in the home can include:

·         Routine medical care, an annual wellness visit, and management of chronic disease(s);

·         Addressing an urgent medical need;

·         Vaccinations, wound care, and other procedures;

·         Management of cognitive and neurological disorders;

·         Coordination of diagnostic testing such as blood tests, EKGs, ultrasounds, x-rays;

·         Care coordination with community services and other healthcare providers including specialists in psychiatry, podiatry, optometry, dentistry and more;

·         Advanced care planning; and

·         Caregiver support and guidance on managing a patient’s needs.

Will my insurance cover home-based medical care?

For Medicare beneficiaries, services delivered by the HBPC provider are covered under the same Medicare benefits that apply when seeing a provider for an office visit, e.g., Medicare covers 80% while the remaining 20% is subject to deductibles and copays.

Certain Managed Care or Health Maintenance Organization (HMO) health insurance plans may require a referral or for the HBPC provider to be selected as the primary care provider. As available, an HBPC practice in your area can answer specific questions regarding coverage.

How do I know if home-based medical care is right for me or my loved one?

Patients do not need to be formally considered “homebound” to qualify for HBPC. Here are some examples of when HBPC might be in a patient’s best interest:

·         The patient has difficulty leaving the home due to medical conditions such as dementia or physical mobility limitations;

·         The patient requires medical devices or special assistance/transportation accommodations to leave the home;

·         Leaving the home can adversely affect the patient’s physical and/or mental health;

·         Caregivers and/or other family members are not available or able to transport the patient; and/or

·         A patient transitioning from one healthcare setting to another needs assistance with “bridging a primary care gap.”

What is the best way to talk with my healthcare provider about transitioning to home-based primary care?

If HBPC seems like a good fit for you or someone you care for, discuss it first with your current primary healthcare provider or healthcare system. They may be able to refer you to an HBPC provider.

The following “conversation starters” may help during that discussion:

·         Leaving the home is very difficult for me/the person I care for and prevents me/them from coming to see you as often as needed. What are the options for receiving primary medical care at home?

·         My medication refills are out. It’s been more than a year since I last visited the clinic, and I am unable to get there due to my medical condition(s). Can you recommend or refer me to a home-based primary care provider so that I can continue to receive the primary medical care I need at home?

For more information about the modern-day house call and home-based medical care, please visit the Home Centered Care Institute.

Julie Sacks is the president and chief executive officer of the Home Centered Care Institute (HCCI), a national nonprofit organization focused on scaling home-based primary care and bringing it into the healthcare mainstream. In the role, Sacks is responsible for evaluating strategic opportunities and partnerships, developing relationships with donors and foundations, and serving as spokesperson for the organization, in addition to serving as the primary liaison to the HCCI board of directors.