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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 needs.
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 unconventional field.
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 demonstrated.
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?
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.