Homebound patients have always faced daunting logistical and financial challenges in finding basic care. Now, the COVID-19 pandemic, which particularly devastated America’s nursing homes, has painfully demonstrated the fragility of their safety net. But my hope, as a physician who makes home visits, is that the pandemic will help us rediscover the power of the house call.
I work with a practice called Housecall Doctors P.C. in Highland, Indiana, which has treated more than 6,500 homebound patients over the last decade. We’re an interdisciplinary care team that goes beyond primary care to ensure access to specialty treatments. Our team includes nurses, two internists, a podiatrist, a wound-care specialist, and a nurse practitioner. I joined as the team’s interventional radiologist to provide critical treatments that can be done outside the hospital, such as ultrasound-guided needle biopsy, gastrostomy tube management, paracentesis and thoracentesis, wound care, and drug infusions.
As a team, we deliver care where it is often unavailable, and the results have been remarkable. Within a 12-month period ending last August, we treated more than 1,000 patients, reduced emergency department usage by 77 percent, and cut hospital readmissions by 50 percent, according to a study that I co-authored that was selected for publication at this year’s Society of Interventional Radiology Annual Scientific Meeting. Moreover, patient satisfaction scores increased from 17 percent to 84 percent after the implementation of the program.
COVID-19 has caused some physicians, insurance companies, and even the federal government to take special notice of the power of care models that reach out to patients. The Centers for Medicare and Medicaid Services (CMS) issued new rules at the onset of the pandemic to allow Home Health Agencies (HHAs) to provide services to Medicare beneficiaries through telehealth and to treat patients in their homes who are suspected of contracting COVID-19 or who have a condition that makes them more susceptible to the virus. They also allow for more flexibility on who is eligible to receive home healthcare and which clinicians are allowed to deliver care. These changes can help advance the house call model and help keep the most vulnerable patients in our communities safe. Our practice began in 2010 when a group of primary care physicians saw how many of their patients struggled to find specialty care because they lacked transportation and/or financial resources. As a result, these people were getting lost in the system.
The pandemic has exacerbated the barriers and struggles for homebound patients. But this crisis could have a silver lining if it prompts us to create a smarter model: while hospitals treat the most acute cases, more sick patients could be treated in their homes, where they recover better and quicker. With buy-in from CMS and a growing number of insurance companies, I am optimistic that more practices like ours will open in the future. My hope is that with the new CMS rules, and the innovation being spurred by this pandemic, more physicians will take up this powerful model of care in their own areas.
All it takes is a team of clinicians working together to get it started in your community. To do this, first look for opportunities to partner with other physicians. Start by approaching those you already know, and grow from there. Or reach out to physicians who have started a house call program and discuss joining the team. It’s important to include a mix of healthcare providers from various disciplines and specialties to ensure you can offer your patients multiple options. These partnerships have been instrumental in getting our practice off the ground.
Whatever our “new normal” looks like after this is all over, COVID-19 will undoubtedly change how we deliver care. I hope that we can take this as an opportunity to form new partnerships, cross specialty lines, and, in a sense, rediscover our roots in bringing care into people’s homes.