Are house calls making a comeback?

House calls, which disappeared when they became technologically and financially impractical, are now being touted as the latest, cost-efficient way to prevent readmissions of chronically ill and elderly patients.

R. Knight Steel, MD, director of the Home Care Institute at Hackensack University Medical Center and his aides at the University of Medicine and Dentistry of New Jersey, New Jersey Medical School in Newark are promoting the cause by working with the Association of American Medical Colleges to design a model curriculum to train doctors to make house calls again.

The program will provide six medical schools with $70,000 stipends to integrate home care training into their current curricula, tentatively scheduled to begin by the fall.

The need for house calls has arisen as better medical care enable people with chronic illness to live longer and to be discharged sooner. These homebound patients often have difficulty finding transportation to their doctors’ office and end up hospitalized, a costly outcome.

A 1992 study revealed that 6.5 times as many Medicare patients were hospitalized than visited a doctor’s office that year.

Advocates of house calls say they will cut these costly hospitalization rates. Portable X-ray and electrocardiogram machines, heart monitors, and laboratory test kits now enable physicians to care for patients outside the hospital. House calls began disappearing after World War II when patients had to go to hospitals to gain access to cutting-edge technology.

Proponents also say house calls benefit physicians by revealing the human side of their patients, their home environment, and their families. The physician sees what the patient is dealing with, knowledge critical to reducing readmissions.

One hurdle remains, though, in convincing doctors to make house calls, advocates say. For the physician, house calls do not make financial sense. Physicians can see four or five patients in the office in the time it takes to make one house call. Medicare and other insurers don’t reimburse doctors for travel or the visit’s full cost.