We love cool, practical innovations, especially the kind that give seemingly outdated practices a second chance at life. Think of it as upcycling for healthcare – applying the old in a way that is relevant and modern.
This time it’s the long-forgotten house call. That’s right, physicians, particularly primary care docs, are pumping new life into this old-fashioned practice, and (spoiler alert!) it’s really working.
The good ol’ days
Back in the day, physicians regularly left their offices to visit patients in their homes, particularly those too ill or incapacitated to make the trip to see the doctor. Somewhere along the way, probably around the 1960s, that practice became unsustainable, and let’s face it, unprofitable. Communities expanded outside of the urban nucleus, putting greater distance between consumers and providers, limiting the number of patients that could be seen on a given day. If you were a physician and your business model was based on the volume of patients you could see and the volume of services you could provide to those patients, it just didn’t behoove you to leave your office, get in your car, drive across town, spend 30 minutes or more with your patient, get back in your car, drive back across town… You get the picture.
Back to the future
So why the change? What’s motivating physicians to invest the time to make good, old-fashioned house calls?
One, it’s because they work. Most physicians would opt to visit a patient at home if that was best for the patient. They understand that someone’s home is sometimes the most appropriate and accessible care setting, and absent that choice, many people would go without to the detriment of their health and well-being. Supporting house calls helps prevent illness, improve health and well-being, and curb costs. Our broken reimbursement system, however, has made that incredibly difficult.
Two, the “graying of America” means a huge population of older citizens, many of whom live with chronic illness, but have mobility issues that prevent them from getting the care they need. House calls are a critical option for these individuals.
Three, and maybe the most significant influence, the massive shift away from fee-for-service to models driven by patient value has re-opened the door to the house call as a viable delivery channel for health.
Making a difference
Longtime advocates of home-based care – like the American Academy for Home Care Medicine, the VNA Health Group, and the Visiting Physicians’ Association – have understood the value of making house calls and providing care in the home for years, passionately delivering these services despite the economic headwinds. As the market redefines health and healthcare, the industry is rediscovering what these groups have known all along: the house call is an important tool for avoiding illness, reducing avoidable spend, and improving health status among some of the nation’s most vulnerable.
Recognizing these trends, and the desire among seniors to stay in their homes as long as possible, the Centers for Medicaid and Medicare Services (CMS) launched the Independence at Home (IAH) demonstration project. Under the initiative, Medicare recipients with multiple chronic conditions receive comprehensive primary care services in their homes. The intent is to improve quality and lower costs. Savings of about $33M have been reported for the period covering 2015 and 2016, with CMS paying out approximately $17M in quality incentives. That averages about $1,695 in net savings per beneficiary per year.* Not bad. And while there aren’t any statistics regarding patient satisfaction, it’s probably fair to assume that the patients involved are healthier and happier.
Putting it in context
While we wait and see whether CMS decides to open the IAH program to more beneficiaries – and we hope they do – the initiative underscores a bigger point about our changing industry. It signals the broad shift in mentality from a focus on sick care to that of health status. It supports payment transformation via the transition from fee-for-service to fee-for-value. It responds to consumer preferences for choice and convenience. It makes use of digital health, as house calls are enabled through these tools. And, as we stated at the beginning, it may not be a new idea, but it’s absolutely innovative.
House calls are an important element of a smart health market – we hope they’re here to stay.
*Based on an average of 9,442 beneficiaries per year.