She finally found the one of her patient, Katherine Talmo.
It’s easier for Talmo if Li, a geriatrician, comes to her. The 90-year-old doesn’t get out nearly as much since she stopped driving nine years ago. But she is determined to stay in her home.
“If I was in a nursing home, I’d only live for one more year,” she said. “But if I live at home, I’ll live to be 100.”
The notion of doctors making house calls harkens back to an era before HMOs, medical centers and outpatient surgery centers.
Those visits offer insights not available during a 15-minute office visit. Doctors learn more about a patient’s lifestyle, eating habits, their ability to take medicine and exercise.
“They know you’re on their turf and that makes them much more relaxed and more comfortable and more willing to answer questions,” said Li, who directs Christiana Care Health System’s home-visit program. “You learn a lot of things that they wouldn’t even consider saying in the office.”
There are about 4,000 doctors who make house calls in the United States, a number that is expected to grow if a provision in the health care reform bill is successful. Known as the Independence at Home Act, the provision is intended to encourage more doctors to make house calls by allowing them to share in any savings if they can prove they reduced hospital use, improved quality care and left patients satisfied with their treatment.
The program will focus on the sickest and oldest patients. If doctor-supervised home-visit teams are able to reduce the projected annual medical costs of their at-home patients by at least 5%, those savings would be split between the medical organizations and the federal Centers for Medicare and Medicaid Services, which would implement the program. The health care reform law calls for the program to start in January 2012, but Sen. Ron Wyden, D-Ore., and Rep. Edward J. Markey, D-Mass., who introduced the legislation, are pushing for it to start earlier.
The concept also has had “absolute rock-solid bipartisan support” among federal lawmakers, said Constance F. Row, executive director of the American Academy of Home Care Physicians. The amount paid by Medicare for home visits — while higher than for office visits — isn’t enough to motivate more doctors to drive to their patients.
“It meets the things that both parties stand for — to reduce costs while increasing quality,” Row said.
Talmo had a cast on her right hand for a broken wrist suffered in a fall. She also has chronic back pain and numbness in her left leg.
She was standing and smiling when Li entered the room. She greeted Li with a hug and opened a container of waffle cookies to share. The two sat next to each other on the living room couch. Li opened her laptop, where she stores patient medical records.
“How’s your pain right now?” Li said.
“My leg still gets numb, and if I stand up, it hurts.”
“How’s your appetite? Is it good?”
Talmo looked down at her stomach.
“Yes, it’s good — can’t you tell?”
Li checked Talmo’s breathing with a stethoscope. She placed a pulse oximeter on Talmo’s finger to find out how much oxygen she had in her blood. The advent of portable medical tools has equipped doctors to do “almost everything you’d do in an office,” Li said.
One of Li’s goals with her patients is to avoid an unplanned ambulance trip to the emergency room.
But Li said reimbursements are still inadequate. For example, a doctor gets about $54 for a new patient being seen at home compared with about $37 for a new patient being seen at the office. But considering home visits take about 45 minutes, plus another 15 minutes of drive time, Li said the extra $17 is not worth it. She can see up to 14 patients in the office. At most, she’s able to see eight a day on the road.
Near the end of Talmo’s appointment, Li discussed an MRI to get a clearer idea of why she’s in pain. Talmo gave her a kiss on the cheek before she left.
Li then drove to Stanton to see Judy Ahrens, who hardly ever leaves her house because of her conditions, which include arthritis and fibromyalgia. Glenn Ahrens, Judy’s husband, said the home visits are the best approach.
“It means a lot that they come to us,” he said. “We feel that they’re like guardian angels.”