Are house calls coming back?

The ultimate form of patient-focused care may be making a comeback. Staff from a New Jersey hospital are working with the Association of American Medical Colleges to design a model curriculum to train doctors to make house calls again.

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 will give six medical schools $70,000 stipends to integrate home care training into their current curricula, perhaps by the fall.

House calls, once a common feature of health care, began disappearing after World War II when patients had to go to hospitals to gain access to cutting-edge technology. However, house calls now are proving useful all over again as better medical care enables people with chronic illnesses to live longer and be discharged from inpatient care sooner. These homebound patients often have difficulty finding transportation to their doctors’ offices and end up rehospitalized, a costly outcome.

House calls will reduce hospital bed days, according to house-call advocates. Portable X-ray and electrocardiogram machines, heart monitors, and laboratory test kits now enable physicians to care for patients outside the hospital.

Proponents also say house calls benefit physicians by revealing more of the human side of the patient through his or her home environment and family. The physician sees more of the patient’s overall life situation, which can prove useful in improving the patient’s general health and reducing readmissions.

One hurdle remains, though, in convincing doctors to make house calls. 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.