The house call is 'making a comeback'

VA, private companies embrace at-home doctors visits

Physician house calls used to play a major role in patient care—but then they disappeared. Writing in the New York Times, health policy expert Ezekiel Emanuel explains why house calls are making their return 50 years later.

In 1930, house calls accounted for about 40% of patients' interactions with physicians, Emanuel writes. By 1980, that percentage dropped to 1% and more doctors were referring patients to the hospital.

"But after a half-century, the house call is making a comeback," Emanuel contends. He acknowledges that comprehensive data on the trend is not yet available. One study estimates that about 4,000 physicians conducted more than two million house calls in 2010.

According to Emanuel, house visits can be an efficient way to provide care for various medical needs, including:

  • Urgent care. Although many urgent-care problems can be treated through house calls, patients still head to hospitals; urgent-care problems account for about 40% of ED visits each year.
  • Primary care and chronic conditions. According to Emanuel, a few small studies indicate that at-home primary care visits may decrease hospitalization rates by more than 60%, saving 25% in total costs.
  • Hospital at home. Conceived by Johns Hopkins Hospital, this concept focuses on patients who would otherwise be admitted to a hospital for conditions like pneumonia, instead setting up medical equipment in a patient's home. In addition to being monitored remotely through diagnostic tools, physicians and nurses visit patients daily. A study conducted through a Veterans Affairs center in Philadelphia found that these house calls reduced costs by 43%, too.

Employers get on board—and take house calls digital

Emanuel notes that some companies—including Microsoft and Costco—provide house calls to their employees through Carena. The Seattle-area service contracts a physician or nurse to visit employees at home and assess the patients' issue using a computer algorithm that determines whether the individual requires ED care. Visits may be covered by the employee health plan and cost about $500.

In 2010, Carena added "virtual" house calls—at about $85 per visit—through webcams. About 75% of virtual house calls can be treated without a trip to an ED or follow-up visit with a physician, the company says.

Meanwhile, the Department of Veterans Affairs has pioneered house calls that focus on patients with chronic conditions, and the Affordable Care Act in 2012 began funding a project to assess the best care settings for house calls (Emanuel, "The Opinionator," New York Times, 9/5).


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