A well-planned day of out-of-office visits can be as productive as a day in the office, and with great reward.
Nitro Primary Care is one of the few practices in the area that offers home visits. I truly enjoy visiting patients that are homebound or in personal care homes and assisted living facilities in order to provide a level of care to them that they would not receive otherwise.
Years ago physicians did home visits as part of their normal daily routine. But as the pressure from managed care and government payers increased, practitioners felt the pressure to decrease overhead and modify patient visits.
In my opinion, a well-planned day of out-of-office visits can be as productive as a day in the office, and with great reward. The patients I see, by definition, are homebound. Medicare has developed fairly strict guidelines but, in essence, if it is a taxing effort to leave the house and on a regular basis the patient does not leave the home, they are considered to be homebound. Medicare has put in exceptions such as religious events, short trips to the hair dresser and such.
I prefer to do the home visits in conjunction with a home health company. This allows for a whole team approach to care and for multiple disciplines to be involved in the care of the patient. Most home health companies offer physical, occupational and speech therapy as well as skilled nursing and social worker consults.
With modern technology there is little we can’t do in the home. I can easily check blood pressure, pulse, oxygen levels, and glucose. We can draw any blood work you may need, as well as have a portable X-ray technician come to your house and perform X-rays. With the use of smart phones and iPads we can do EKGs and review your medical records from our office or even get your records from local hospitals.
Home visits also allow us to reduce readmission to the hospital. Recent studies published in the New England Journal of Medicine (Jencks SF et al. N Engl J Med 2009;360:1418-1428) showed that over 50% of those readmitted in Medicare did not have an outpatient visit. We know that a comprehensive transition to home discharge plan that includes nurse visits, as well as good physician follow-up, can reduce readmissions.
If you or a family member are homebound I encourage you to find a physician that is willing to do home visits. A great source is the American Academy of Home Care Physicians.
Finding the right fit and availability in your area may be a challenge, but physicians do still make house calls.
