Return of the house call

House calls by physicians have gone the way of the dodo bird. It used to be the norm for doctors to visit their ailing patients at home, but that model gave way long ago to office based practices, a setting which enables a physician to see many more patients than would be possible in the old time model. If anything it would seem like house calls by physicians would be even less tenable in an era of team-based care, which seeks to leverage the scarce physician resource with mid-level providers, nurses, and administrators.And yet at least a few solo physicians are making house calls again, and a column in HealthLeaders argues that it could even make sense for hospitals to offer house calls as a new service line.I like the logic.The office setting is convenient for the physician, but it’s inconvenient for patients, especially the sickest ones, for whom getting out of the house and into the office is a major ordeal, especially for those who require help with transportation and logistics.  In an era where prevention of hospital admissions and readmissions is seen as a key strategy to reduce healthcare costs, and where accountable care organizations are focused on outcomes rather than volume, there may be a new role for doctors in the home. And indeed, a doctor featured in the HealthLeaders article discusses his ability to keep even quite sick patients out of the hospital.Diagnostic and information technology is evolving, too, in ways that help physicians be productive on the road. In fact the “Bring Your Own Device” phenomenon of doctors bringing their own iPads into the hospital demonstrates that physicians don’t have to make any information technology tradeoffs when they leave the office. New portable ultrasound machines are another example of technology that can easily be brought into the home.When a physician visits a patient at home he or she can gain a much better sense of the overall context for the patient’s health. An empathetic, astute, holistically oriented physician should be able to turn that information into a better care plan and prevent unneeded escalation to an acute setting.Another potential benefit is that patients can avoid sitting in a germy waiting room and potentially being exposed to dangerous infections as a byproduct of their doctor visit.Of course, much of the same logic that applies to house calls for doctors applies to nurses as well. But it’s reassuring that the economics support the reintroduction of such highly trained professionals into the home. photo credit: Bibi via photopin cc---By healthcare consultant David E. Williams of the Health Business Group