Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

The Return of House Calls

7/31/2012 6:39:20 PM | 3 comments

Back in the old days medicine was practiced through home visits.  In the early 20th century, as healthcare became institutionalized and medical insurance replaced ‘pay-as-you-go’, home visits became a thing of the past. Today there are a multitude of factors that are giving the practice of home visits a second look, and I think this is a positive development.

Rapid advances in mobile technology open the door to health records and devices that previously could not have been accessed in a home such as blood tests, monitors, collaborating with digital photos, and even x-rays. For patients who are in-between needing the services of a SNF yet need care and have a difficult time getting to the provider, a home visit can be much more effective than a phone call.

I am not advocating for all practioners to add mandatory visits to the homes of patients to their already packed schedules. But I do think that visits from nurse practitioners and physician assistants could fill an important need at a reasonable cost.  For example, during a home visit the provider can learn more about the patient’s lifestyle, eating habits, and their ability to take medicine and exercise

In addition, there is a provision in the ACA called the Independent at Home Act that advocates for and even incentivizes home visits to reduce readmissions and streamline costs.  In this way the costs of home visits could be paid for by the savings it creates, and even save money for a hospital in the long run.

Early results from the pilot programs are promising.  The Urban Medical Housecall Program in Boston is treating nearly 600 high-cost Medicare beneficiaries with multiple chronic diseases and has reduced hospital admissions for those patients by 29 percent.  In addition, the VA’s Home-Based Primary Care program, which treats patients with chronic conditions, has received a patient satisfaction of 82.7 percent – the highest satisfaction rating ever received by a VA health care program.

The Independence at Home program mirrors the health care reform law’s biggest and most important objectives: increase the quality of care for patients and to reduce costs. And in thinking about technology advancement that allows more timely and detailed information, home treatments will quickly continue to gain in effectiveness. The fact that this help could also save money in the long run for the hospital is the type of “win win” that is necessary for us to face the healthcare challenges of the future.  But most importantly, for someone who is stuck at home, seeing the face of the provider could make all the difference in itself.

I completely agree with home visits by our allied health providers as a reasonable and cost-effective way of participating in the Acute Care Continuum. Whether we provide the service or align with our local Foundations/ACO/Medical Homes, this is one way we can share in the "bundled payments" piece of the pie. My only question is: how/who do we begin this endeavor with?
8/20/2012 7:32:09 PM

Allison Whitney
An article in Sunday's Boston Globe makes the same point about the positive impact of home visits on caring for more than the patient's immediate medical symptoms ( And at the same time, it brings up another cost issue - who pays for these services?
8/6/2012 8:40:49 PM

Katherine Ahern
This is the first I've heard of the Independent at Home Act, it looks like such good public policy! I was struck by Dr. Gawande's description of how many clues about a patient's ability to follow a care plan are in the home, and this post makes the connection that the house call could provide a use case for mobile health technology that could be enormously effective, really extending the "continuum of care."
8/2/2012 11:37:46 PM