JustCare

Tag: House calls

  • Seven questions to ask before scheduling a house call with a doctor you don’t know

    Seven questions to ask before scheduling a house call with a doctor you don’t know

    Without a doubt, many of us would prefer a house call from a friendly primary care doctor than a trip to the doctor’s office or, if necessary, the emergency room. And, people with chronic and disabling conditions in particular may find it hard to leave home to visit the doctor. With no doctor available to make a house call, many older adults skip needed care and end up in hospital or, worse still, having an ambulance take them to the emergency room.

    With the right medical team, house calls can be a good alternative to an emergency room visit. Indeed, house calls are on the rise for people with Medicare, up 40 percent between 1998 and 2004. And, in 2013, Medicare paid for more than 2.6 million house call visits. Medicare pays for home health care services from Medicare-certified home health agencies in some cases when a patient is homebound and for hospice care at home in some cases when a patient is terminally ill.

    Medicare is now in the midst of a small demonstration project to determine whether house calls for patients with chronic conditions can improve care and save money. If you or someone you love is not participating in that demonstration project or cannot find a doctor you know to make a house call, one emerging health care business makes it easy to summon a doctor for a house call via a smartphone app.

    Before scheduling a house call with a doctor you do not know, check in with your primary care doctor. You want to make sure that the doctor who makes the house call will meet your needs. Here are seven questions to ask:

    1. Will the doctor provide quality care? Find out whether the doctor is board certified in internal medicine or family practice medicine. Also, check out the doctor with your local hospital, health system, Area Agency on Aging or other community resource. If they are not familiar with the doctor, they might have a doctor who makes house calls to recommend.
    2. Will the doctor take the time to understand your medical conditions, including current medications, allergies and chronic conditions?
    3. Is the doctor part of a medical team that includes nurses, therapists, social workers and pharmacists who can provide additional support?
    4. Is the doctor bringing portable diagnostic equipment and medical supplies to properly diagnose your condition?
    5. Will the doctor assess the home environment for safety and health risks?
    6. Will the doctor develop a plan of care and be in touch with your primary care doctor to coordinate your care?
    7. Will you need to pay out of pocket or will Medicare reimburse for this service? Ask whether the doctor accepts Medicare. If the doctor accepts Medicare, traditional Medicare should pay and your charges should be capped. If you’re enrolled in a Medicare Advantage plan, call the plan to see whether there are in-network providers who make house calls.

    For more information about the advantages of house calls and what you need to think about, read this publication by Leading Age.

  • Medicare finding ways to cover house calls and save money at once

    Medicare finding ways to cover house calls and save money at once

    Can Medicare deliver better care at home to older patients with multiple chronic conditions and save money in the process? Based on Year One practice results of Medicare’s Independence at Home Demonstration, the answer is a resounding “Yes.” In its first year, the Demonstration both improved health outcomes for patients with multiple chronic conditions and saved Medicare $25 million.

    The Demonstration is funded through the Affordable Care Act with the goal of improving quality of care and quality of life for older patients with multiple care needs. It is designed to keep patients at home and out of institutions—be they hospitals or nursing home. The Demonstration gives doctors and nurse practitioners more time with their patients and allows them to assess their home environment. And, it is designed to improve both caregiver and patient satisfaction.

    Patients in the Demonstration must be enrolled in traditional Medicare, have two or more chronic conditions and have been hospitalized in the prior 12 months. They receive comprehensive primary care tailored to their needs for a three-year period. The care team coordinates their care. The Centers for Medicare and Medicaid Services is tracking the patients’ care experiences through quality measures. Providers in the demonstration that succeed at reducing costs receive incentive payments.

    Begun in 2012, fifteen sites throughout the country are engaged in this project, including Boston Medical Center, Cleveland Clinic Home Care Services, North-Shore Long Island Jewish Health Care and Dallas VPA.

    This demonstration is one of a number of pilots Medicare is supporting to test ways of delivering care that allow older adults to age in place. Click here to read about another such project. Right now, other than through these demonstration projects, Medicare only covers limited home care services for patients needing physical therapy or nursing care and for whom leaving home requires a considerable and taxing effort.