House calls make a comeback as health-care option

By Christina E. Sanchez • THE TENNESSEAN • January 13, 2010 Nashville nurse practitioner Jason Boylan's exam room can be someone else's living room. When he needs to see a sick patient, he hops into his blue Hyundai sedan with a backpack full of medical supplies, visiting those too sick to visit him. He travels to sick people who can't get to a clinic. The patient's house becomes his exam room. House calls, the norm in the early 20th century, are slowly re-emerging as a niche area of medicine, gaining popularity in the last decade. Doctors and family nurse practitioners visit patients who can't or don't want to get out. Sometimes the house calls are made after hours, saving patients a costly emergency room visit for simple maladies such as ear infections, the flu and joint pain. "There is a lot you can do outside an office setting just by using a stethoscope, otoscope and your clinical acumen," said Boylan, who owns Nashville House Calls and co-owns a walk-in clinic, 3rd and Church Health Care. "For some people, it's about convenience, but house calls eliminate unnecessary ER visits and save people money." About 3 million house calls were made across the country in 2009, up from just over 2 million the previous year, according to the American Academy of Home Care Physicians, a national membership organization for providers and nurses. The organization estimates that 4,000 of the nation's 817,000 doctors make house calls nationwide, though nurse practitioners increasingly have taken over many of the visits. No concrete numbers exist on how many doctors or nurses in Tennessee will visit the home. The group's Web site lists fewer than a dozen such operations scattered across Tennessee, including in Murfreesboro, Memphis, Cleveland and Woodbury. For most house-call services, the process is simple: Call to set up a visit, explain the problem and wait for the medical professional to arrive. Rachel White, a stay-at-home mom with two children, said she likes to use the house call for simple illnesses and as a complement to regular visits with her kids' pediatrician. Boylan visited White's 4-year-old son, Jake, last week for an ear infection. "The last thing you want to do is take your whole family to the doctor office to get one child checked and sit in a waiting room full of sick people," White said. "It's really a convenience factor when you don't want to have to drive across town to the doctor for something like an ear infection." Blue Cross Blue Shield of Tennessee is the only private insurance in the state that covers house calls. The White family's cost was a $25 co-pay, the same as an office visit. People without insurance, or whose insurance won't cover house calls, pay on average $125 for a home visit, depending on services rendered. Mimi Gerber, a family nurse practitioner who contracts with Boylan to provide home care, said most people use the visits for upper respiratory infections. "People are slowly recognizing that this is available," said Gerber, who serves East Nashville. "It's a lot more personable. I think I end up spending more time with a patient." Constance Row, executive director of the American Academy of Home Care Physicians, said many of the home visit providers serve primarily elderly patients, a fast-growing segment of the homebound population, because Medicare will cover most home visits. Also, that's where the greatest need exists. Keep problems small "We need somewhere between 10 and 12 million house calls to be made each year," Row said. "But we're facing a combination of reimbursement problems and an inadequate supply of primary care physicians." The health reform bill being considered in Congress may help to grow the reimbursement for providers who want to treat seniors in their home. The Independence at Home Act would allow chronically homebound patients to receive primary care in their home without providers having to jump through hoops to get Medicare to reimburse for service. The theory is that the service would help elderly people get simple problems treated before they lead to more costly services that eat up Medicare funds. April Faircloth Collier, a family nurse practitioner, said she sees a need for house calls among her older patients who can't get out of the house. She owns and runs Hope Family Medicine in Nashville. She also runs Hope House Calls, which she hopes to expand first to a regional, then statewide house call operation for seniors. She is in the process of recruiting 10 to 20 nurse practitioners, and hopes to launch in about three months. "For people who are homebound and have to deal with a cold or a wound, it can be arduous and take a lot of time for them to get to the doctor," Collier said. "This is a way for them to get a primary care provider to come to their house so they won't be exposed to more germs or have to figure out transportation