House calls back in vogue for some doctors
By Jim Salter
ST. LOUIS — Pediatrician Natalie Hodge spent seven years in a hectic doctor’s office. Some days, she’d see 40 sick kids, 10 minutes at a time. Moms calling for advice about sore throats or ear aches had to wait. Hodge could only find time to return those calls as she drove home.
Finally, she had enough.
"I kind of threw up my hands and said, ’There’s got to be a better way to do this,"’ Hodge said. "I said, ’I’m going to get a laptop and a Treo and make house calls."’
For much of America’s history, that was the norm. Home visits died when medical insurance replaced pay-as-you-go, and administrative costs and malpractice insurance fees forced doctors to abandon individual practices and join together in groups. By the early 1970s, fewer than 1 percent of doctors made house calls.
Now, doctors visiting the sick in their homes seems to be in vogue again. The doctor still carries a little black bag, but a laptop bag, too, and perhaps a portable X-ray machine.
Experts say the number of doctors checking patients at home, while still a very small percentage of all doctors, has risen sharply since a Medicare policy change a decade ago that increased reimbursement for home visits. But that change mostly involved house calls to the homebound.
The American Academy of Home Care Physicians doesn’t track how many doctors make house calls, executive director Constance Row said. Neither does the American Medical Association.
Private and public medical insurance typically doesn’t pay for "concierge" services like Hodge’s — that is, house calls borne out of convenience, not necessity. In fact, Hodge’s clients typically pay a $1,500 annual out-of-pocket fee plus a charge for every visit.
Dr. Steven Landers, medical director for home health care at Cleveland Clinic, said house calls can mean better patient care.
"The real benefit is the access," said Landers, who makes about 20 house calls per week to geriatric and chronically ill patients. "You get to see people in their own environment. You learn things you wouldn’t normally know."
Row said too many frail and elderly people skip seeing the doctor simply because it is too difficult to make the trip to the office. For them, she said, home visits are essential.
"This is one of these areas where the need has outstripped the capacity," Row said. "There are more people who need the service than there are physicians who provide it."
House calls today are made easier by advances in technology. Hodge said that for most visits, she needs little more than her iPhone, a laptop and a high-tech cooling system for medicine. Landers checks a patient’s chart and schedules the next appointment on the laptop he carries with him.
Mobile technology means doctors can perform blood tests and X-rays inside a patient’s home. Digital photos can be e-mailed to specialists. New data storage systems keep all the information safe.
Hodge, 39, was a University of Kentucky medical student doing a stint in Hazard, Ky., when she got her first taste of house calls. "I would drive up into little hollers, taking care of guys who wouldn’t come into the clinic, coal miners," she said.
She did her pediatrics residency at Washington University in St. Louis, then began working in a multi-specialty office here. By 2005, she grew weary of what she found to be impersonal, inadequate care.
So she launched her house call practice, Personal Pediatrics. She started a Web site and the business took off. It was so successful she plans to expand nationally. And as the business expands, Hodge hopes to partner with a charitable foundation that could offset the annual fee, making the service available to a broader audience.
The benefit is convenience. No more phone tag with the doctor’s office, no more dragging a sick kid out of bed. When parents have a question, they call or e-mail Hodge directly.
On a recent chilly morning, Hodge visited 7-year-old Elizabeth Cupini, who stayed home from school with a sore throat, sneezing and coughing.
Snug in a pink bed decorated with Teddy bears, Elizabeth opened wide as Hodge used a small flashlight to examine her throat.
"Well, you have a pulse so I think you’re going to live," the doctor said as the girl giggled. Nothing worse than a bad cold, the doctor told Elizabeth and her mom.
The bottom line, Hodge said, is that house calls make for better care.
"If they have asthma, you can say, ’get rid of this carpet or these drapes.’ If they’re overweight or diabetic, you can see what’s in the fridge or the candy jar," she said.
It’s that sort of connection that Landers said is simply lacking in the current health care system.
"The real power is the basic things that made the house call useful 50 years ago," he said. "The patients and families find it to be a very caring gesture. Sometimes just showing that you care is the most important thing."