The idea of a doctor entering the home to treat a patient, a type of medical visit otherwise known as a “house call,” may bring to mind television sitcoms of yesteryear rather than the current health care landscape.
But as the COVID-19 emergency continues and more people start to embrace home-based care, there’s a case being made for more education around house calls for prospective doctors.
In the first half of the 20th century, house calls were more common in the U.S. In more recent times, this changed — and one of the key reasons for the sudden shift toward brick-and-mortar care has to do with reimbursement. That’s according to Dr. Elizabeth Davis, a primary care physician at Rush University Medical Center.
“It largely reflects the way our health care system is set up and the way reimbursement works for physician services, which, until recently, has largely been physicians or providers getting paid based on how many visits they do,” Davis told Home Health Care News. “Although there are payment rates for home visits, when you take into account how much time it takes to travel and to do a high-quality home visit, it’s hard for these programs to make ends meet.”
Despite today’s challenges, Rush University Medical Center’s house calls program, “Rush@Home,” works to deliver all sorts of primary care services in the home. That includes bloodwork, immunizations, in-home x-rays, refilling medications and advance care planning in the home setting.
Davis is part of the program’s care team. As part of the program, Rush@Home also collaborates with home health companies for support when it comes to nursing and physical therapy.
Generally speaking, prospective doctors have a long road ahead of them. That journey includes four years of medical school, then three to seven years of residency training. After completing residency, many physicians also become board certified in their chosen specialty.
At Rush University Medical Center, first-year medical students are often exposed to house calls, according to Davis.
“As they move through medical school, they get into their clinical years where they’re spending all their time doing clinical work, and so we are integrating house calls into that,” she said. “When they’re doing their primary care rotation, they do house calls as part of that. Moving into residency, similarly, they have blocks of time where they’re doing ambulatory care, outpatient care, and so we’re exposing them at that point.”
As students progress through medical school, clinical rotations are a primary focus. Yet Davis believes that it’s important for more medical schools to integrate home-based primary care into their rotations.
“Ideally, it’s a part of all outpatient training, but I think the reality is that probably very few programs have training in this,” she said. “That’s one of the reasons that we’re excited about expanding Rush@Home. It will expand our ability to train residents routinely.”
Broadly, programs like Rush@Home increase care access for homebound patients with complex needs. For individuals that fall under this category, receiving care outside of the home can be difficult — or out of the question entirely.
About 2 million seniors are permanently homebound, according to the American Academy of Home Care Medicine.
At the Home Centered Care Institute (HCCI), one of the main objectives is providing education around the opportunity for house calls, according to Julie Sacks, president and COO of the organization.
“Right now, only about 15% of the patients that need house calls — and when I say ‘need,’ I’m talking about high-risk patients — are getting them,” she said. “With 85% of the people that need this kind of care not getting it, we knew that we needed to train people and bring people into the field.”
Schaumburg, Illinois-based HCCI is a nonprofit organization that advocates for the expansion of home-based primary care.
In order to train doctors and prospective doctors, HCCI has developed a comprehensive home-based primary care curriculum. HCCI has partnered with a number of institutions, including the MedStar House Call Program and the Icahn School of Medicine at Mount Sinai, for the program.
The program consists of foundational courses that have been condensed into two workshops, as well as Continuing Medical Education accredited webinars and online courses for more in-depth training. HCCI’s program trains on both the business and clinical side of home-based primary care.
“We have found that the clinicians need education on how this practice operates most efficiently and also the sustainability of the business model,” Sacks said. “The practice-operations folks benefit from understanding some of the clinical activities involved in treating this patient group.”
While courses are crucial, Sacks also stresses the value of getting training in the field.
Along these lines, HCCI has a shadowing program with multispecialty academic hospital Cleveland Clinic. HCCI has plans to eventually launch this program in Chicago.
“It’s one day of shadowing a clinical person and one day of shadowing some of the processes that go on. And at Cleveland Clinic, they have a telemedicine program,” Sacks said. “People can add a third day of observation to understand and learn about that telemedicine program.”
Ultimately, Sacks believes house calls can lead to better care.
“There tends to be a relationship that’s really built in a trust when you invite somebody into your home,” she said. “This can be helpful, not just from a medical and physical perspective, but also from an emotional perspective. A lot of these folks are isolated and don’t have a lot of interaction. Knowing you have a doctor out there watching out for your best interest can really be meaningful.”
Companies featured in this article:
Rush University Medical Center, The Home Centered Care Institute
