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The return of doctor house calls: Convenient, but at what cost?

An alert popped up on Dr. Sam Kim's smartphone: a 7-year-old with a cough. Would you be comfortable seeing this patient?

Kim clicked yes and hopped in his car on a recent Saturday morning. Black bag in hand, white coat donned, he knocked on the door of a home on a tree-lined street in La Canada Flintridge.

The doctor is in.

Kim works for Heal, a Los Angeles-based start-up that allows patients in several California counties to order doctor house calls through a smartphone app. Similar companies exist in other parts of the country, including Pager in New York City and Mend in Dallas.

Health advocates generally support using technology to make medical care more convenient. As these companies grow, however, some question the return of the house call.

A century ago, most medical visits were in the patient's home. But cities got bigger and doctors began using more equipment, therefore it made sense for them to not travel more than 10 steps from patient room to patient room.

"It's much more cost-effective to bring the patient to the doctor than the doctor to the patient," said Dr. Ateev Mehrotra, a Harvard health policy professor who studies innovations in medical care. "That's why we as a society moved away from house calls."

And that's still the case, experts say, especially when many parts of the country are experiencing physician shortages exacerbated by the large numbers of people newly insured under the Affordable Care Act.

On that Saturday, Kim, a pediatrician, listened to Lila Dancsecs' chest with a stethoscope in the living room of her home. He peered into her ears and throat.

The diagnosis: a run-of-the-mill cold. No antibiotics required. Kim prescribed rest and fluids.

Most days, Kim works at a private practice in the San Fernando Valley. But he likes talking to patients and their families for a longer time when he takes calls for Heal two days a week.

Instead of rushing through a packed schedule, he can spend up to an hour with each child in their home. "I have that luxury," he said.

Doctors have advocated for more in-home care for seniors and the chronically ill, who may have trouble with transportation and would benefit from having their medical providers work together in one place. At-home visits have also become a sort of novelty service for the wealthy, known as concierge medicine.

But some are wary of scaling up that model for everyone when there's a limited supply of physicians. The Assn. of American Medical Colleges estimates there will be up to a 90,000 doctor shortfall nationwide by 2025.

Physicians for Heal, who are chauffeured by medical assistants, spend a few minutes updating patient records and reading about their next visit in the car, but much of that time is unproductive. Kim said one shift can take him across the L.A. region, from Downey to Manhattan Beach.

"It's a very, very inefficient process for a doctor, especially in L.A.," Mehrotra said. "All that travel time is not cheap."

Because she used Heal, Lila's mother, Soraya, avoided a trip to the emergency room that weekend morning. She had initially called her daughter's pediatrician, but there weren't any appointments available. "This is just so much more convenient," she said.

More than 60% of the app's first-time users would have gone to the emergency room if they hadn't used Heal, according to company co-founder Dr. Renee Dua, who launched the company last year.

On-demand doctors are one of several ways entrepreneurs are trying to make healthcare easier to access. But experts say that unlike other innovations, doctor house calls don't appear to decrease overhead or use cheaper medical providers to cut costs.

Such services also probably can't reach people in remote parts of the country, far from the nearest physician, said Melissa Buckley with the nonprofit California HealthCare Foundation. So when discussing how to aid the most underserved Americans, "we don't think first about Heal or Pager," she said.

Gorkem Sevinc, managing director of Johns Hopkins Medicine Technology Innovation Center, said he expects house call start-ups to grow because people like the convenience. The challenge will be to not misuse doctors' time and determine the right level of medical care for each patient's problem, Sevinc said. Not everyone needs to see a physician, he said.

"We don't want healthcare to be commoditized like a cab ride," he said.

Coincidentally, an app built by a former engineer for ride-sharing service Uber tries to address that issue. Pager, which was co-founded by a creator of the taxi-on-demand company, began offering doctor house calls in New York City in 2014.

When people open the Pager app, they chat with a nurse via text message and describe their symptoms. The nurse then decides whether the patient needs an in-person visit from a physician or a videochat consultation.

"It really allows us to direct patients in the right direction so that we don't send them a doctor when they don't need a doctor," said company co-founder Gaspard de Dreuzy. When patients do need a house call, physicians use Uber to get around Manhattan.

For all doctor house call services, one big appeal is the flat fee.

As insurance plans' deductibles have risen, people are more concerned than ever about the cost of each treatment.

But if you try to ask a hospital how much something would cost in the emergency room, "they refuse to answer," said Dr. Jonathan Clarke, who started Mend in Dallas. "It's not what we expect from any service industry."

Mend, which employs ER doctors, nurse practitioners and physicians assistants, costs between $50 and $199 per visit. Depending on the kind of visit, Pager's prices range from $50 to $200.

Soraya Dancsecs, the mother of Kim's patient, liked knowing the price of the visit before Kim showed up. A house call from a Heal physician costs $99, but her insurance covered the treatment, so she paid only $20.

"It was simple," she said.

soumya.karlamangla@latimes.com

Twitter: @skarlamangla

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