Are Doctor Home Visits Making a Comeback?

May 23, 2018

The old practice of doctor home visits -- they used to be known as house calls -- is making a comeback. The Centers for Disease Control estimates that in 20 years, two-thirds of elderly Americans will have multiple chronic conditions, making it difficult for them to get to a doctor’s office.  That means they'll need more care at home.  WMRA’s Peter Jump rode along with one physician squeezing a house call into his busy day.

[Knock on door, “Hello!”…]

It’s a cold, rainy day. Dr. Brooke Bostic, a physician with Sentara Greene Family Medicine in Ruckersville, is making a hospice visit to an elderly gentleman in the advanced stages of Alzheimer’s Disease. His wife Marcia greets us.

MARCIA: Hello. Is it time for our visit?

BROOKE BOSTIC: Yes, it’s good to see you.  We’re going to go back and see Mr. Gibson. How’s he been doing?

MARCIA: He keeps his eyes closed a whole lot. He doesn’t always eat everything I give him anymore.

Like most physicians Bostic’s day is one office appointment after another.  But several times a week he uses his lunch break to make home visits.  They start with a hurried car trip into the countryside, frequently navigating dirt roads.  Bostic has about 20 home visit patients. Many of the patients are in hospice.

BOSTIC: I focus my attention on just how to make the days a little better and if there’s little pieces that I can improve upon I feel that is a success that is improving their quality of life or helping to head off a bad outcome before it happens.

Bostic asks Marcia questions to help him make an assessment. Home health aides make frequent visits, but Marcia is her husband’s chief caregiver.  It’s a pattern familiar to millions of families – spouses and adult children, often elderly and infirm themselves, looking after very sick people.

After getting the update from Marcia, Bostic goes to see her husband, taking his time to do a thorough physical exam before giving Marcia his thoughts and then once again hurriedly leaving to get back on the road.

On the drive back Bostic reflects on the visit and his work.

BOSTIC: The pros of me making home visits are: me seeing the patient in their home environment; going over their medicines they are actually taking; they’re a great convenience to the patient who may not be able to get into the office without a whole lot of support, and may not be able to stand up and transition to a wheelchair.

And home visits help alleviate the stress and discomfort of the inevitable.

BOSTIC: As time goes by you just get weaker or worse and you go to the hospital because of a crisis, you come out and you’re weaker than when you went in.

In making home visits Bostic is making a difficult decision. The traditional fee for service model of the U.S. health care system works against home visits. Why spend 20 minutes on the road, 45 minutes with a patient and then spend another 20 minutes rushing back to the office when you can shuffle several patients in and out of your office every hour?

The choice may soon become easier.

AARON YAO: If we can provide care at home, timely, it may well reduce emergency visits and hospitalization and eventually saves Medicare money.

Aaron Yao is an assistant professor of health care policy at the University of Virginia. He points to initiatives by several agencies including the Centers for Medicare and Medicaid Services, or CMS.

YAO: There are pilot programs going on like the Independence at Home demonstration project within CMS so that’s a cost-sharing experiment where if house calls save Medicare money the savings are shared with the doctors.

Ultimately, Yao believes that an expansion in home visits will be driven by demographics.

YAO: In the Medicare population the average age of a patient receiving home visits is about 83 years old and they have multiple chronic conditions.

And, that simple truth means that as our population ages many healthcare professionals are likely to spend more time visiting patients in the place they do best -- and the place they want to be -- their home.