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Federal Program Studies The Bygone Medical Tradition Of House Calls

The life of a doctor has changed dramatically in modern times. 

The days of turning up at a patient’s home, medical bag in hand, for a lengthy discussion about health and lifestyle are long gone. 

But  the federal government is looking at the possibility that house calls by a health care professional might be a better and cheaper way of providing treatment, especially for people who are really sick.

Kristian Foden-Vencil visited a Portland non-profit that makes house calls. It’s participating in a federal study.

At the front door of a small foster home in Tigard, nurse practioner J. C. Provost makes his first house call of the day.

Resident: “Hello.”

Kristian Foden-Vencil / OPB
J.C. Provost visits Elizabeth Rains, who is in her 80’s and suffers from dementia, a least once a month.

J.C. Provost: “Hello, good morning. How are you.”

Resident: “Good.”

He’s visiting Elizabeth Rains, who is in her 80’s and suffers from dementia. She has a delicate heart and takes the blood thinner, Coumadin. It’s a tricky prescription because the thickness of her blood is changed by everything from what she eats, to how much water she drinks.

Provost visits Rains at least once a month.

J.C. Provost: “I’m going to check your blood pressure now. Okay?

Elizabeth Rains: “Okay.”

After a series of blood tests, Provost discovers Rains is sub-theraputic, meaning he needs to adjust her medication.

J.C. Provost: “So, it’s not unheard of with the change of season from what I’ve seen. People start eating more greens which provides more vitamin K, which is the antidote of Coumadin. So, I probably will have to increase her Coumadin right now. If it’s not thin, she’s having a high risk of having a blood clot migrate to either her brain her lungs or her leg. All right Elizabeth, guess who’s seeing me next week?”

Elizabeth Rains: “Okay.”

Nurse Practioner J.C. Provost

Kristian Foden-Vencil / OPB

A blood clot could mean death, disability or all kinds of other painful and expensive problems — not to mention a trip to the ER and a long stay in an intensive care unit.

Liviu Voinea stands next to Provost and Rains during the visit. He owns and runs this foster home. His job also includes watching over Rains and the other residents — to make sure they’re healthy. He says these monthly house calls save residents stressful visits to the doctor.

Liviu Voinea: “We have pretty much 24/7 if we have an emergency or if we have a question or if we make a call we get a response right back. So there is no doctor visit like waiting rooms, there is no waiting time.”

Most of the patients at this home are on Medicare or Medicaid.

Provost thinks his house calls probably save the government hundreds if not thousands of dollars per patient per year.

J.C. Provost: “If I were not going to these people’s homes, probably a good 40 percent would not get primary care, period. Because going to a doctor’s office is something impossible.

Kristian: “And so eventually they would end up in the ER or some much more expensive place.”

J.C. Provost: “In a catastrophic fashion, absolutely.”

The federal government is interested in finding out whether house calls will keep sick and elderly Americans in better health.

So, the government’s Center for Medicare and Medicaid Services, has selected the Portland non-profit Housecall Providers and 15 similar outfits around the nation, to study.

Housecall Provider executive director, Terri Hobbs, is confident the program will show significant savings.

The average ER visit in Portland is $1500, she says. Her health care professionals are reimbursed by the government at the rate of up to $100 a visit. The reimbursement can vary depending on whether it’s a doctor or a nurse practitioner who makes the call. 

Terri Hobbs:”So cost wise for the Medicare system, just saving that one ER visit, they paid for our services for a year.”

Oregon Senator Ron Wyden wrote legislation to create the demonstration project as part of the federal Affordable Care Act.

He says the Veterans Administration tried a similar program, where really sick vets were visited at home.

Ron Wyden: “And the VA saved more than 20 percent on their population that was getting cared for at home. So for me, I think the potential in the years ahead is to save billions and billions of dollars.”

He says house calls focus attention on the 20 percent of Medicare recipients who use up to 75 percent of the money.

The federal study runs for the next three years.

Doctor Richard Gilfillan is the Director of the Center for Medicare and Medicaid Innovation in Baltimore, Maryland.

Richard Gilfillan: “So we’re hoping to see improvements in health outcomes, that is better health for the patients, improvement of the experience of care for these folks so that they’re going to feel, both they and their families will feel like they’ve got a great care system operating for them and they;’re receiving great care. And over time we think that this better care will actually result in a lower total cost of care for these folks.”

Any provider that can show it has reduced costs per patient by a significant amount could be rewarded with a portion of those savings.


This story is part of a reporting partnership between Oregon Public Broadcasting, NPR and Kaiser Health News.

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