Return of
the House Call

.

By Jennifer Thomas
From HealthScoutNews

Published: May 2003

When Veronique Mastey had her second child, the baby's shallow breathing and lack of appetite alerted her that something was wrong.

Mastey soon found out her daughter had a life-threatening heart abnormality called Tetralogy of Fallot.

Her daughter, now 4, has had four heart surgeries to repair the defects, and her condition makes her prone to pneumonia and passing out from lack of blood to her lungs.

Mastey and her husband have lost count of the nights they jumped out of bed, dressed, and rushed to the emergency room — only to wait several hours to see a doctor.

During one late-night trip, Mastey began to wonder if there could be a better way. In her native France, she remembered, doctors came to her home.

So she decided to take some action on her own. In December, Mastey founded SOS MD4U, one of a small but growing number of services that lets you pick up the phone and request that a doctor come to your home. SOS MD4U guarantees that a physician will arrive within within the same day of a call to their Toll free number 1 866 SOS-MD4U.

"The idea is to bring the old-fashionedness back to reality," says Mastey, whose company is based in Los Angeles. "With my daughter, she did not always need to go to the emergency room. There were things that could have been done for her by a doctor at home."

Efficiency vs. the Personal Touch

As many graying baby boomers can attest, house calls were commonplace in the United States until the early 1960s. But then, efficiency and cost concerns won out over the personal touch.

By the 1980s, house calls had all but disappeared, says Constance Row, executive director of the American Academy of Home Care Physicians.

Though no one tracks the number of house calls billed to private insurers or paid for out-of-pocket, U.S. doctors billed Medicaid for 1.6 million visits to patients' homes in 2001, an increase of about 100,000 from the previous year, according to government statistics.

Most of those calls were for frail, homebound elderly, says Row, whose non-profit organization teaches "the art and science" of house calls to doctors.

Row believes the need for doctors who'll make house calls is greater than ever as the population ages.

House calls cost more than an office visit. But if the homebound elderly were getting the care they needed to help manage chronic illnesses such as diabetes, it would keep them out of the hospital, lowering their health-care costs overall, Row says.

"Two million housebound elderly cannot get to the physician's office," she says. "The current model does not deal with chronic illness well."

Paying More for Privacy

There's another new niche for doctors who make house calls, one that so far appeals mainly to the affluent, although practitioners are hoping to market to more average consumers.

Companies such as Mastey's SOS MD4U and AM-PM House Calls, started nine years ago in Florida, are hoping to convince the masses that it's worth paying extra for privacy, comfort and convenience.

Dr. Ramsey Saffouri, a family practice physician from Miami, Fla., came up with the idea for AM-PM House Calls after making a house call to Frank Sinatra more than a decade ago.

"None of the VIPs liked waiting in the doctor's office," Saffouri says. "I thought, 'If the VIPs didn't like it, a lot of other people probably didn't like it either.' "

AM-PM House Calls now has 6,000 doctors on call in 22 cities across the nation, including Dallas, Denver, Houston, Kansas City, New York, Las Vegas, Reno and San Francisco.

Physicians go to hotels to treat ill travelers who have no idea where to find the nearest 24-hour clinic or emergency room. They're called to offices to treat busy executives. Some families have the doctors do at-home physicals on the entire family, saving multiple trips to the doctor's office.

AM-PM physicians have treated food poisoning, asthma attacks, dog bites, fractures, stitched wounds and also done rapid strep tests — "anything a primary-care physician would take care of," Saffouri says.

An Office on the Go

As medical technology has evolved, doctors can do more things in the home that were previously available only in the office. There are portable sonograms, radiology equipment for X-rays, pulse oxymeters (to measure blood oxygen levels), even EKGs (to measure heart rhythm).

And computerized medical records now allow doctors to access medical histories on their laptops, Row says.

Saffouri's physicians have arrangements with local pharmacies to deliver prescription medicines to the patient's door, Saffouri says.

The costs for house calls are generally more than an office visit. AM-PM House Calls charges $325 to $375; SOS MD4U, which currently serves only Los Angeles, charges a $60 admin fee with PPO Insurance and deductible met.. The cost of treatments can run hundreds or even thousands more. You pay up front, but you can always try to bill your insurance company afterward, Saffouri says.

The concept is catching on, Saffouri says. The first year he was in business, he billed $150,000. Last year, his company billed $18 million and his physicians made 20,000 home visits.

"I really believe house calls are having a comeback," he says. "People are becoming more and more dissatisfied with the health care system. They are looking for options."