Why I Make House Calls

January 14, 2011

I was once asked by a classmate of mine, “Why in the world do you take the extra time to go on house calls? Have you lost your mind?” My response was that I feel that I am doing exactly what I was called to do.

I was once asked by a classmate of mine, “Why in the world do you take the extra time to go on house calls? Have you lost your mind?” My response was that I feel that I am doing exactly what I was called to do. A home visit is a wonderful way for the physician to experience the true surroundings in which their patient lives. There is also a large financial burden that patients must bear when they request non-emergent medical transport via EMS. Most carriers charge a base flat rate plus a per mile charge. Such total costs can surpass $500-600 for a simple round trip. 

One such example of one of my earliest house calls was a 105-year-old female, Ms. Jones we will call her, that was unable to see a doctor for five years. Ms. Jones never had an actual emergent complaint and her family was unable to afford the high cost of transport. Her previous physician stopped supervising the home health nurse visits she was receiving because the patient was unable to go to the physician’s office. Ms. Jones’ family called our office to see if I would be able to care for the patient. I traveled to see the patient at her home for her initial visit. When I arrived, her family indicated their surprise at the fact that I was actually making a house call. After going through her list of medical problems and the few medications she was taking, I realized that Ms. Jones was not sick. She was just old. She did not have uncontrolled hypertension, diabetes, dyslipidemia, and the usual array of medical problems that I had suspected. She did in fact have severe osteoporosis and also had chronic decubitus ulcerations on the buttocks. As it turns out, Ms. Jones was blind, deaf, and had no way of being able to interact with her family.

I was able to provide care for Ms. Jones for almost one year before she died. During that time, I was able to avoid at least three hospitalizations for her and also allowed her family to keep their promise to her by keeping her at home as long as they could. The care the patient received is no different than any of my other colleagues would have provided. The only difference was the location of the care.

I have found that my elderly homebound patients and their families are very grateful for the care I provide. Yes, it does take extra time and yes, I could certainly be a more efficient and a more profitable physician if I stayed in the office and allowed the patients to come to me. A quick review of the current E&M codes will show you that CMS does recognize care provided to patients at their residence and the reimbursement provided is a bit higher than a routine office visit:

• 99341-99345 Home visit, new patient, level 1-5
• 99347-99350 Home visit, established patient, level 1-4

Skeptics might say this care is not possible for the average primary care physician. You might say that your time is too valuable. Of course it would not make sense to schedule a house call during the busiest time of your day. House calls can be completed on your way to or from work. House calls are also a great way to use your lunch break for something productive and can help to break the tension during a very busy day.

Patients visited at home never complain about wait times. They never begin the encounter with a list of long complaints. In my experience, the sickest patients always wear the largest smile. On days when a house call is scheduled, I find myself feeling a bit more energized than I normally do. If you have not previously scheduled a house call in the past, do yourself a favor and try it. You might just find out that you have been missing out on a true blessing!