Why did doctors stop doing house calls?
There was a time when most physician visits were made in the patients’ homes. However, as technology progressed, hospitals began to offer better diagnostic and treatment tools. Inventions such as the X-ray machine and laboratory tests changed the way medicine was practiced. Physicians started bringing patients to the hospital to take advantage of these tools. Eventually, they set up offices with this high-tech equipment and patients came to see them, and then things got really efficient. They could line up people in their rooms and see twenty to thirty people in a day! Making house calls was less efficient, but doctors still tried to meet their patients’ needs by providing house calls when their patients were very sick. Then medical costs began to soar as more and more expensive tests, treatments, and medicines became available. In an effort to cut costs, Medicare and managed care started to reimburse less for a physician’s time and instead pay mostly by procedure. As our nation’s medical costs continue to increase, primary care physicians’ reimbursement continues to decrease. Now, physicians are forced to work longer days and see more patients just to cover the costs of running their practices. Most physicians simply cannot afford to make house calls.
The sickest patients are not receiving the care they need. If their condition worsens and they cannot be seen soon enough, they need to be hospitalized. The severity of their illness often leaves them weakened, requiring prolonged rehabilitation. Many of these fragile patients fail to make a complete recovery, and bounce back and forth between hospitals, skilled nursing facilities, and home. Emergency rooms and urgent care clinics are crowded with costly emergencies that a prompt house call could have prevented or lessened the severity. With increasing frequency, the emergency rooms are providing non-emergent care for patients who have no other access to care.
What’s the solution?
Medicare increased the reimbursement for house calls. This allowed the start of house call based practices. What a physician loses in efficiency of having to go from patient home to patient home, they save in overhead costs of running a clinic. However, the real change came with portable technology. Now a physician can bring the clinic tools (X-ray, laboratory tests, EKG) to the patient’s home. With an electronic health record, a physician can carry every patient’s medical file, making it easier to attend urgent calls. House calls are back, and bring many benefits: Medicare saves money from hospitalizations and emergency room visits, physicians can choose whether they want to make 10 house calls or see 30 patients in an office each day, and most importantly, quality care can go to the very patients that need it the most.
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