Here are some quick basic FAQ’s:
1. The Need and Where
We Are Today
We estimate 4 million frail elderly Americans need primary
medical care brought to their homes because their serious multiple illnesses
and disability make them unable to access office-based care. There are many
others under 65 who also need this service such as those with chronic diseases
such as ALS. And of course others would like to have house calls on a
convenience basis to keep them at work, or allow their children to be cared for
in the home
As it stands today, the focus has been nearly exclusively on
the needs of the frail elderly. The
Medicare fee for service program pays for house calls in private homes and
domiciliary care facilities for those with the "medical necessity” of this
care. The cost is affordable—only slightly above the cost of an office
visit. We are pleased at the growth in
Medicare home visits to 5.2 million visits in 2012 to private home and
domiciliary care facilities (assisted living). However, this represents only about 12% of the
estimated total need for that population (see below).
With regard to other populations, and other styles of home
care medicine programs: there are some employer-sponsored programs (such as at
Microsoft) that provide house calls as an employee benefit, some managed care
providers who provide either one-time assessments, transitional care
management, or in some cases
longitudinal care. Also, some concierge practices provide house calls on a
private pay basis. Finally, though not covered by Medicare, the Hospital at
Home program is provided at some hospitals to patients who otherwise would be
in the ICU.
2. How do I find a house call provider?
The only national listing of providers is our website
listing which is focused principally on the frail elderly population. Click
here to visit our Locate a Provider page.
If you do not find a provider on the list and are in the
Medicare population, go to your local Office on Aging, home health agency or
discharge planner as there may be someone in your area who could serve your
3. Why Try To Make the Numbers Grow—Reduced
Cost, Improved Quality, What People Want
There are lots of reasons why the need for house calls has
not been met. First, until recently, the cost of excessive use of institutions
has not been a public policy issue. Second, and related to the first, providers
are not trained to make house calls, and the reimbursement system in this
country does not cover costs, let alone reward those who go into this
But we believe all of that is about to change. The numbers
of frail elderly are growing and with them unsustainable costs. The data shows that house calls can reduce
hospitalizations by 60%, and VA data shows a 24% reduction in overall costs.
Seniors want to age in place, not in institutions. Congress, public policy makers, and managed
care plans are becoming acquainted with the potential for cost savings, and
taking action. The workforce issues are
being addressed: housecall programs make use not just of scarce primary care
physician talent, but the valuable talents and skills of nurse practitioners
and physician assistants. This "team” approach shows the potential for helping
to solve the workforce shortage program. Finally, safety—even in the inner
city—can be addressed, as the many house call programs who serve the poor have
In truth, the issue
is whether this country can afford not
to support the growth of house calls for those in need, not whether it can.
4. Technology: the issue or the answer?
Technology is what has made it possible for mobile providers to bring
primary care to patients in need of care in their homes. Electronic Medical
Records, smart phones, and miniaturized
lab tests, and mobile imaging mean that studies normally provided through
primary care offices now are generally available for use in the home—and sometimes
more including ER-level tests.
It is also true that some believe that the healthcare of
most Americans can be managed by remote control, (telemonitoring) and that
technology has or will replace the need for healthcare professionals taking
care of patients. At this point, most
home care medicine providers see technologies as an assist, not a substitute
for hands on care.
We are the Academy are all for technology. However, boundaries
of use need to be defined. We look to the VA and others to show us data on the
effective use of technology in home care medicine including the use of
telemonitoring and to the experience of our members in defining the need of
mobile providers for industry information.
5. Independence At Home: What is it?
This CMS Demonstration program began in 2012 and is
demonstrating how home care medicine can help reduce costs and improve care for
the sickest of the frail elderly.