When I think about physician home visits, the first image that comes to mind is of a doctor walking into a home with a stethoscope around his or her neck, carrying a larger-than-life bag filled with medical supplies—a picture from the first half of the 20th century.
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However, physician home visits are making a modern-day comeback, in part because these visits provide an opportunity to more effectively serve homebound, high-risk patients. Results from a home-based primary care demonstration program suggest that providing these services saved Medicare and participating providers $33 million through reduced ED visits, hospitalizations, and 30-day readmissions.
Today's home visits have come a long way—in fact, their resurgence can be seen as just one home health initiative that health systems nationwide are developing to improve service for patients who are at risk for hospitalizations or visits the ED.
As we've talked with these programs, three main teaching points for anyone interested in implementing their own program have been raised:
Home visit programs typically bill for services, but due to the limited number of visits performed everyday—it just takes time to get to places—these programs may present a limited revenue opportunity for a health system.
However, physician home visits can reduce ED visits and hospitalizations. For patients enrolled for at least 12 months in the home visit program at one organization we spoke with, there was a 43% reduction in ED visits and a 47% reduction in hospitalizations.
Even with support to develop a program, coordinating various departments can be a challenge. Home health, post-acute care, and geriatrics representatives are needed to help train physicians performing home visits.
Imaging, labs, and pharmacies need to be organized to understand the specific needs of the target population group. Without proper coordination, the home visit program can struggle to achieve an ROI.
Providers in a home visit program must be comfortable working independently, because they almost exclusively perform visits alone. The ability to make patients comfortable in their own home, regardless of the patient's socioeconomic status, can greatly improve the success of a visit. Typical home care providers have many years of experience and are looking to expand their skills beyond traditional clinical settings.
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