It goes without saying that in the 3+ decades that I've been a doctor, I've seen a lot of changes in the medical profession. Many of these changes have been difficult, of course -- plummeting time with patients, ludicrous paperwork, and illogical financial incentives, among them.
From time to time, however, I see big changes in medicine that are deeply positive. The most powerful and progressive changes are happening through:
- Thoughtful integration of simple "good medicine"
- Alignment with current political and financial realities
- Creative use of existing technologies.
The "return of the house call" is one of these fantastic trends. For a long time, it has looked like the house call went the way of the doctor's bag -- a nice idea but not something that fits our current reality. Recently, however, there has been a resurgence in house calls and home care for everything from palliative care to wound care to concierge medicine.
The return to medical providers visiting patients at home is supported by common incentives and the current political climate. For instance, the Affordable Care Act penalizes readmissions within 30 days of discharge; integrated home care is seen as one way to decrease readmissions and improve outcomes. Also, a focus on a "fee for performance" rather than a "fee for service" model, and an overall push to cut costs, has encouraged the "house call" approach. Finally, as the New York Times reports, "Home care is generally cheaper than hospital care, and for more than a decade, government programs such as Medicare and Medicaid have worked to create incentives for hospitals to switch to less-expensive treatment."
Because home care is removed from the traditional hospital setting, medical collaboration is crucial to successful home care.
For instance, a 2007 study, by Dr. Richard Brumley and colleagues, found that palliative care patients who received in-home interdisciplinary care were less likely to visit the emergency room or be admitted to the hospital than those receiving standard home care. This resulted in lower costs. For house calls and home care to really work, they need to incorporate providers across specialities and across the continuum of care. Providers must collaborate because it is not efficient for every provider to visit the patient at home, but a home visit can be a crucial part of an integrated approach. And telemedicine is the key for this kind of medical collaboration to be effective, cost-efficient, and time-sensitive.
We've found that house calls and home care are especially powerful when the following components are in place:
- Healthcare providers at all points in the spectrum are included.
- Multiple specialties collaborate on a single patient.
- Tools like store-and-forward telemedicine are used to enable rapid and time-sensitive consults.
- There is a focus on medical collaboration in service of good patient outcomes (rather than a simple "counting" of visits or services.)
For our Quick Guide on medical collaboration, click here:
Image courtesy of myfuturedotcom on Flickr, used under Creative Commons rights.