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From the Hospital to the Home

From the Hospital to the Home

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How House Calls Bring Primary Care to Patients Anywhere

For patients with chronic health conditions, getting to a physician’s office for an appointment is not only difficult but also potentially dangerous. Fortunately, there are a handful of physicians who are part of a national movement reviving an old care-delivery model with a modern twist: the physician house call visit.

In the Chicago area, the national effort to revive physician house calls takes the form of Northwestern Medicine HomeCare Physicians, who provide comprehensive medical care to over 7,500 patients in the comfort of their own homes. The program, one of the most experienced in the country, recently celebrated its 20th anniversary and surpassed a milestone of more than 100,000 house call visits.

“A century ago, house calls by physicians were the norm, but by the 1990s less than one percent of physician visits were done in the home,” says Thomas Cornwell, MD, a family medicine physician at Northwestern Regional Medical Group and founder of HomeCare Physicians. “Our experience over the past two decades has demonstrated that this ‘old care-delivery’ system could play an important role in providing better patient care.

Health care spending is highly concentrated among chronically ill patients, with the top five percent accounting for nearly half of the total expenditures, according to the Agency for Healthcare Research and Quality.

“Home centered care can dramatically improve the quality of life for complex and homebound patients, their families and caregivers, while also decreasing health care costs associated with hospital visits or nursing home placement,” says Dr. Cornwell.

Technology, which was once a barrier for home visits, has evolved and many advanced tests can more easily be done in the home, including X-rays, ultrasounds and EKGs. Smartphone apps assist with diagnosis, guidelines and medication management and therapeutic devices, such as home ventilators, can be managed on site.

Paul Chiang, MD, medical director for HomeCare Physicians, jokes that one of the most significant improvements in technology is GPS helping him map out and navigate where he needs to go. HomeCare Physicians provide house calls in an area that spans east-west from Wheaton to Geneva, and north-south from Bartlett down to Naperville.

Four days a week, Dr. Chiang and a medical assistant visit eight to ten patients. A visit can include a routine physical, blood work, immunizations, administering injections and checking wounds. Physicians will also make special visits to assess new symptoms or illness. Dr. Chiang says an added benefit of the house call is the ability to assess the patient’s environment.

“When I am in your home, I can see how you live, what you struggle with, how you celebrate life. I can understand you in ways that the best test at the hospital cannot reveal,” says Dr. Chiang. “It is a very personal experience for me, the patient and the patient’s family. I am able to build a level of comfort and trust that is not always possible in an office building.”

Dr. Cornwell, who also serves as Chief Executive Officer of the Home Centered Care Institute, is advocating at a national level to ensure more patients have a similar home care experience. He is working with lawmakers to encourage passage of the Independence at Home (IAH) Act, which would shift the IAH from a small demonstration project to nationwide Medicare implementation.

“The IAH project demonstrated that home primary medical care can significantly decrease health costs by reducing expensive hospitalizations and readmissions,” said Dr. Cornwell.

The limited program, which only covered 10,000 beneficiaries, saved Medicare over $35 million during the first two years, explains Dr. Cornwell. “Imagine the impact if we could expand this program nationwide to two million Medicare beneficiaries with severe chronic illness and disability,” he says.

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