A century ago, the sight of a doctor making house calls was the norm. The practice has largely faded, but as industry trends change, house calls may be making a comeback.
In the 1940s, about 40 percent of all doctor-patient interactions occurred through house calls, a practice that had been commonplace since the earliest days of professional medicine.
However, by the 1980s, house calls had dropped dramatically, accounting for less than 1 percent doctor-patient interactions, largely because it made more fiscal sense for patients to come to the doctor.
“It’s much more cost-effective to bring the patient to the doctor than the doctor to the patient,” Dr. Ateev Mehrotra, a Harvard health policy professor, told the Los Angeles Times in March. “That’s why we as a society moved away from house calls.”
The reasons were simple: population, and therefore clientele, greatly increased over that time; cities grew, making travel difficult; and it was much easier to store the equipment doctors use in one office rather than lug it about town.
Yet, the practice of making house calls has seen a modest increase as both physicians and patients turn away from the bureaucratic nature of the health care industry toward a more personalized form of health care.
According to an American Academy of Family Physicians survey, 13 percent of family physicians made regular house calls in 2013, and 3 percent made more than two a week.
Another study, according to an opinion piece in The New York Times by health policy analyst Ezekiel Emanuel, found more than 4,000 physicians made more than 2 million house calls in 2010.
“Health care is headed back to the future,” Emanuel wrote in 2013. “House calls are a sign that we will all see our health care going back to the ‘old days’ when … the doctor came to our homes, giving us real personalized medicine – and saving money at the same time.”
In Durango and La Plata County, there are a few options for in-home patient health care.
Recently, JoAnn Kargul, a board-certified family nurse practitioner who just moved to Durango, launched Aspen Medical, a one-person operation that offers same-day care at a patient’s home.
“I think there’s a need for it,” Kargul said. “If you’re sick with bronchitis, the last thing you want to do is see if you can get an appointment the same day, and then go sit in a waiting room.”
Kargul said she was fed up with dealing with insurance companies and, instead, decided to make house calls, offering general family practice care, charging $85 to $145 per visit. That way, she can spend as much time as needed with the patient.
“Way back when, I was working in office in New Mexico, listening to a doctor and (a nurse practitioner) say one saw 33 patients and the other saw 45,” she said. “And I don’t care how good they are, they missed something, and they probably missed a lot. I never wanted to brag that’s what I did.”
The San Juan Basin Health Department, too, offers a variety of in-home patient care services, though much more specialized than general family health, spokeswoman Claire Ninde said.
The Medical Home model through care coordination services “ensure that all clients have a medical home base with a primary care provider,” Ninde said. The program allows for home visits for people who qualify.
Staff members will also make home visits for the Nurse Family Partnership program, which is for first-time mothers who can receive care from pregnancy until the child is 2 years old. The program has a maximum caseload of 75 women, and Ninde said it averaged 71 women per month in 2016, averaging three visits a month per client.
The Single Point Entry program, offered through Medicaid, provides services to elderly, blind and disabled patients in an effort to allow them to remain at home and receive care rather than being placed in a long-term care facility. The program served about 380 clients, 240 of which were seen in their homes once a year and 139 visited twice a year.
And the “Protomotor” program offers care that can include home visits to Spanish speaking clients, as well as underserved, low-income or disabled clients, Ninde said. The local health department also sends out staffers to Cedar View Apartments, a residence for low-income elderly people, about 10 times a year to visit 15 clients.
House visits can supplement certain forms of health care, but the practice is limited in what care can be provided. Yet, the fact the age-old practice is being embraced once again signals to industry experts that the future of health care is uncertain.
“It’s difficult to say how that will pan out, but I do think there’s a definite trend toward expanding health care,” Robert Wergin, president of American Academy of Family Physicians, told U.S. News & World Report last year. “Physicians and patients alike are both looking for a better health care experience, and I think this is definitely one of the avenues you’ll see more of.”
jromeo@durangoherald.com
Aspen Medical
To contact Aspen Medical, call JoAnn Kargul at (970) 445-8443.
