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Nurse practitioner Beth Hungate visits patient Mary Spicer every four to six weeks. A team making house calls in Richmond, Va., is subsidized by the Virginia Commonwealth University medical center. (Eva Russo / For The Times / August 19, 2009) |
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Reporting from Richmond, Va. -
Fanning out through this city's old neighborhoods, doctors and nurses from a local medical center have adopted a practice that harks back to a bygone era: They're making house calls.
Surprising as it may seem, this throwback approach may offer a path toward the elusive goal of providing better medical treatment at lower cost.
And although the proposal has generated fewer fireworks than the proposed new government insurance plan, experts say it may help transform the nation's healthcare system.
Lawmakers on Capitol Hill are poised to make house calls a building block of President Obama's promised healthcare overhaul.
"This is one of the most promising ideas I have seen," said Elaine Ryan, a vice president at AARP, the influential seniors group. "It is not only a cost saver . . . it is something that addresses really the most critical issue for Medicare beneficiaries."
The core idea is deceptively simple: By staying in close touch with some of their sickest patients through home visits, doctors and nurse practitioners can avoid admitting them to hospitals, where costs and potential complications multiply.
"These patients are having preventable complications. When they get discharged from the hospital, they are having avoidable readmissions," said Dr. Mark McClellan, who oversaw Medicare in the Bush administration. "Improvements in care could yield big savings."
Like most other ideas for helping the troubled healthcare system, implementing this idea on a national scale probably wouldn't be easy. And the stakes are high.
Medicare, which provides health insurance to about 45 million mostly older Americans, is expected to run out of money in just eight years. Just 10% of Medicare beneficiaries -- most of them suffering from multiple chronic conditions -- account for nearly two-thirds of Medicare spending.
Despite numerous attempts over the last decade, the federal government still hasn't found a formula that both assures top-quality care and reins in spending.
"Our experience hasn't been very good," acknowledged Timothy P. Love, who heads the Office of Research, Development and Information at the Centers for Medicare and Medicaid Services.
But, Love said, Medicare has not yet tried a house call program led by primary care doctors.
On the streets of Richmond, the seemingly anachronistic practice is producing positive results.
Dr. Peter Boling heads a team of four doctors and five nurse practitioners. They see about 275 homebound patients who live within 15 miles of the hospital, visiting each approximately once a month.
Most of the patients suffer from multiple chronic conditions, such as diabetes, heart disease or Alzheimer's. All are so ill that it had become an ordeal to go to the doctor's office for a routine physical or to check on a worrisome symptom.
It's not uncommon for patients like these to experience mild confusion, for instance, which could signal a stroke or a routine urinary tract infection.
Elsewhere, such an episode often prompts a 911 call, an ambulance ride to the emergency room, a battery of tests and a long hospital stay.
"We call it the million-dollar work-up," nurse practitioner Tammy Krukiel said recently.
Krukiel was visiting Barbara Beasley, a 66-year-old retiree with congestive heart failure.
As Beasley rested in her small apartment, propped up with pillows in her bed so she could watch television, Krukiel took her pulse and made sure she was getting enough oxygen.
Surprising as it may seem, this throwback approach may offer a path toward the elusive goal of providing better medical treatment at lower cost.
And although the proposal has generated fewer fireworks than the proposed new government insurance plan, experts say it may help transform the nation's healthcare system.
Lawmakers on Capitol Hill are poised to make house calls a building block of President Obama's promised healthcare overhaul.
"This is one of the most promising ideas I have seen," said Elaine Ryan, a vice president at AARP, the influential seniors group. "It is not only a cost saver . . . it is something that addresses really the most critical issue for Medicare beneficiaries."
The core idea is deceptively simple: By staying in close touch with some of their sickest patients through home visits, doctors and nurse practitioners can avoid admitting them to hospitals, where costs and potential complications multiply.
"These patients are having preventable complications. When they get discharged from the hospital, they are having avoidable readmissions," said Dr. Mark McClellan, who oversaw Medicare in the Bush administration. "Improvements in care could yield big savings."
Like most other ideas for helping the troubled healthcare system, implementing this idea on a national scale probably wouldn't be easy. And the stakes are high.
Medicare, which provides health insurance to about 45 million mostly older Americans, is expected to run out of money in just eight years. Just 10% of Medicare beneficiaries -- most of them suffering from multiple chronic conditions -- account for nearly two-thirds of Medicare spending.
Despite numerous attempts over the last decade, the federal government still hasn't found a formula that both assures top-quality care and reins in spending.
"Our experience hasn't been very good," acknowledged Timothy P. Love, who heads the Office of Research, Development and Information at the Centers for Medicare and Medicaid Services.
But, Love said, Medicare has not yet tried a house call program led by primary care doctors.
On the streets of Richmond, the seemingly anachronistic practice is producing positive results.
Dr. Peter Boling heads a team of four doctors and five nurse practitioners. They see about 275 homebound patients who live within 15 miles of the hospital, visiting each approximately once a month.
Most of the patients suffer from multiple chronic conditions, such as diabetes, heart disease or Alzheimer's. All are so ill that it had become an ordeal to go to the doctor's office for a routine physical or to check on a worrisome symptom.
It's not uncommon for patients like these to experience mild confusion, for instance, which could signal a stroke or a routine urinary tract infection.
Elsewhere, such an episode often prompts a 911 call, an ambulance ride to the emergency room, a battery of tests and a long hospital stay.
"We call it the million-dollar work-up," nurse practitioner Tammy Krukiel said recently.
Krukiel was visiting Barbara Beasley, a 66-year-old retiree with congestive heart failure.
As Beasley rested in her small apartment, propped up with pillows in her bed so she could watch television, Krukiel took her pulse and made sure she was getting enough oxygen.
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