House calls a possible health care solutionBy PAULINE ARRILLAGA
RICHMOND, Va. —The doctor doesn't look like much of a crusader, bent over the frail frame of 90-year-old Alberta Scott.
He has a lavender stethoscope strung round his neck and some serious bedside manner at work on this stubborn nonagenarian who wants to be anywhere but where she is: in a nursing home bed, hoping to heal and get back home.
"Squeeze my hand," physician Peter Boling prods. "Squeeze my hand. Come on. Hard!"
This is Boling's day job, providing medical care to some of Richmond's oldest and sickest patients. A geriatrician and head of general medicine at Virginia Commonwealth University Medical Center, he visits nursing home patients with a smile, and he leads a team of specialists who take to the road, medical bags in hand, to see patients where and when they need it most — in their own homes, before a crisis lands them in the ER or a nursing facility.
Boling and his team make house calls.
And now he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma.
There are house-calls programs here and there. San Diego. Boston. The Veterans Health Administration cares for thousands in their own homes, saving money by reducing unnecessary hospitalizations and emergency room visits.
But Boling wants to bring house calls to the masses — up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost savings, but to provide a financial incentive to persuade more doctors to return to this kind of work.
Where other proposals have divided lawmakers, the house-calls idea is winning support from Republicans and Democrats alike as a "more cost-effective way for these patients to get the coordinated care they need," says Sen. Richard Burr, R- N.C.
The provision calls for the Medicare program to work with home-based primary care teams to test whether house calls would reduce preventable hospitalizations, ER visits and duplicative diagnostic tests for high-cost, chronically ill patients.
That means patients with at least two chronic conditions who have been hospitalized in the past year and require assistance for at least two daily living activities, such as bathing, dressing, walking or eating.
Patients with multiple chronic conditions account for about two-thirds of Medicare, the almost $500 billion federal health insurance program for seniors.
Mark McClellan, who ran Medicare under President George W. Bush, called the idea one that "could lead to cost-savings and better outcomes" for patients.
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