June 23rd, 2010 by DrAlanDappen in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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A few weeks back, I had introduced a patient who was willing to let her religious beliefs stand in the way of receiving the proper medical treatment she needed to stay alive. I want to revisit with you this dying patient, who hadn’t known me or any doctor for over 30 years.
As the rest of the family, who were not as committed to a religious path, stood by her expectantly, I said to her: “I had a brother who was a true believer in the power of God and that faith could heal all things or be called God’s will. Like you, he was a competent adult in charge of his decisions. He wouldn’t listen to anyone else — not his wife, father, mother, children, brother — not even me, the doctor. He died two years ago, leaving behind 10 children and a wife who depended on him. We all believe he died unnecessarily.
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December 9th, 2009 by DrSteveSimmons in Primary Care Wednesdays
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This upcoming January 4, 2010 will prove an important date for any physician who prescribes durable medical equipment for their patients to use in the home. The Centers for Medicare and Medicaid Services (CMS) have implemented an internet-based enrollment process for Medicare termed PECOS, another progeny of the 1996 HIPAA legislation. PECOS stands for Provider Enrollment, Chain and Ownership System and was created in large part to prevent fraud. Yet when I called the PECOS helpline, fraud was not a concern, and it was explained to me that PECOS is an internet version of my Medicare Application.
Since my practice makes house calls, we treat a variety of home-bound patients unable to make it to a doctor’s office without great effort. We care for stroke patients, quadriplegics, those with end-stage pulmonary disease, and many simply weakened by the effects of advanced age. Most need equipment like mattresses to prevent recurrent pressure sores, wheelchairs, nebulizer machines, or oxygen. A patient depends on their physician’s ability to order anything necessary, and it is imperative this be done without creating an exorbitant financial burden or by denying them a Medicare benefit already paid for. But, according to our Home Supplier, if we haven’t enrolled by January 4 then our Medicare & Medicaid patients will have to pay 100% of the cost for any equipment prescribed. Read more »
October 19th, 2009 by drval in True Stories
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I’m working with a small team of primary care physicians in Vienna, Virginia. Part of their strategic business plan is to offer flu shots to local residents via office visits and house calls. Just last week I accompanied Dr. Alan Dappen on a series of flu shot house calls to the frail elderly. They were too weak to come to the office, but wanted to be protected from life-threatening flu. I was really proud to be able to care for them in their own homes and wondered how many emergency room visits we would avert this season with our strategy.
The answer may be “fewer than I thought” - but not for the reason I expected. As it turns out, a local pharmacy conglomerate has bought up most of the flu vaccine supply, so that our practice can’t get any more. Although we have hundreds of patients requesting flu shots, we just don’t have the goods. And I can tell you that the frail elderly (who would have benefited from our house calls) won’t go to the pharmacy to get them. They’ll be at risk for the flu, and will have to wait until we can get more vaccine - whenever that happens. Read more »
June 6th, 2009 by Berci in Better Health Network
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Who has never heard about Jay Parkinson, founder of HelloHealth service, the first online medical practice? Now please meet Dr. Hodge, the first iPhone doctor.
Hodge’s start-up Personal Pediatrics aims to equip a fleet of self-starter pediatricians in major metro areas with iPhones, cloud-based practice software and the marketing know-how to court new parents, families and corporate health programs alike. The company’s plan points to a growing trend of doctors returning to what was once a mainstay of the profession: the house call.
Hodge has already established that the iPhone doctor model works — after more than a decade working in a pediatrics office in St. Louis, Missouri, where she saw up to 35 patients a day for about 10 minutes each, Hodge traded in the patient assembly line to launch Personal Pediatrics. That was three years ago. Back then she had her laptop and Palm Treo in tow.
I have to mention one thing first. The whole health 2.0 movement is not about transforming the healthcare system into an online service, but there are more and more people who want to reach healthcare services through online or mobile applications.
If there are no patients who want to be online, no doctors will build such services. That’s how it works.
*This blog post was originally published at ScienceRoll*
April 22nd, 2009 by DrAlanDappen in Primary Care Wednesdays
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By: Valerie Tinley, MSN, RNFA, FNP-BC
House calls have long been associated with primary care providers (PCPs), the proverbial “black bag,” and days gone by. Unfortunately, house calls are often just a memory or something we watch in reruns on the television.
Those people that best remember the prevalence of house calls, the elderly, may be the same population whose needs will bring house calls back from the brink of extinction and return them to the mix of services offered by PCPs.
House calls should be a core offering of PCPs, since by nature we help patients from cradle to grave. Therefore, some of these patients may not be able to come to see us because they are too old or too sick or immobile.
Why then can’t PCPs go to these patients? We certainly can solve the majority of primary care problems where our patients want or need to be seen, including in their homes, whether these problems are run of the mill day-to-day issues; or those associated with chronic, continuous care diseases; or even many urgent care issues.
Unfortunately house calls are rarely offered because many PCPs view them as too time consuming and therefore too costly to conduct.
The need for house calls for these populations will not go away. The populations that house calls can help include:
• those that are bed bound, very old, who want to age at home rather than a nursing home;
• those suffering from dementia;
• those recently discharged from the hospital, and unable to be mobile short term or long term; and
• those that are receiving hospice care.
Many of these people cannot leave their home, or more importantly, should not leave the home, to go to the doctor’s office for an office visit. It is important to understand how very expensive this is for the caregiver, in terms of time, lost hours on the job, effort and transportation costs, all to actually get them to the medical provider’s office, because their loved ones have problems with mobility or other hindrances.
The result? There are many in need of medical care that cannot receive it. This increases medical problems and mortality. When healthcare is ignored or foregone for the most routine of problems, more expensive and much more serious healthcare issues arise in its place.
A recent article in the New York Times reported that keeping geriatric patients out of the hospital and getting them the care the need at home can result in a cost savings of between 30% and 60%. In addition, a house call program, piloted by Duke University, has reduced the number of hospital admissions for those patients unable to get to the doctors office by 68% and the number of emergency room admissions by 41%. These patients are thereby healthier, and even safer, working with a PCP that makes house calls.
Several organizations currently offer house calls as a core part of their services offerings, like Urban Medical in Boston, or the practice I am with, doctokr Family Medicine. Also there are beginnings of pilot programs for house calls, like the one at Duke’s Medical School which was mentioned earlier.
But these are only a few providers, and the movement needs to be widespread. Our aged population needs it and we as primary care providers should be listening to their needs and providing for these needs. Otherwise, we are falling short.
Until next week, I remain yours in primary care,
Valerie Tinley MSN, RNFA, FNP-BC
