New York City lawyer Judith Kurzweil is juggling a lot of balls. She works full time and has twin daughters, 10, at home--and more than two years ago, her mother Irene, 86 and struggling with her health, moved in with the family. In Kurzweil's mind, a nursing home was not the right choice. But her mother's poor health made getting her to a doctor very difficult. Kurzweil's solution: Dr. Andrew W. Lyons, a New Age Marcus Welby who makes house calls, little black bag--a padded black computer bag--and all. "It's an amazing lifesaver," says Kurzweil. She has time for her daughters and career, and "Dr. Lyons permits my mother to stay with her family."
The house call is making a comeback. Not a decade ago, doctor visits to the home were declared a "vanishing practice" in the New England Journal of Medicine. Now experts predict that as time-strapped baby boomers age--and their parents survive to be superelderly--the demand for doctors who are as comfortable examining patients in the bedroom as in the office will soar. Medicare data show a 37% surge to more than 2 million home visits by physicians from 1995 to 2005. That is partly because Medicare changed the rules for reimbursement in 1998, making house calls an attractive model on which to build a practice. The rules were further altered for 2006, allowing doctors who visit patients in assisted-living facilities to bill the same rates as for residential visits. Current proposals before Congress could reduce those reimbursement rates, however, making home visits a less attractive option for doctors.
That would be a shame, because one of the fastest-growing segments of the U.S. population is those 85 and up. Many are, like Kurzweil's mother, frail and in need of multiple medications and frequent doctor's care. Since it's hard to get around, they often delay seeking treatment until an illness is full blown and then call 911. That becomes time consuming and costly and can lead to a family crisis. "When elderly patients go to the emergency room, doctors are very uncomfortable about sending them home" right away, says Dr. Joseph W. Spooner of Care Level Management in Woodland Hills, Calif. "So they admit them, and patients stay three or four days." Then the sons and daughters are called in to quickly figure out what to do next.
A regimen of at-home doctors' visits can ward off some of those problems. "We get call after call from desperate relatives," says Constance Row, executive director of the American Academy of Home Care Physicians, a national organization based in Edgewood, Md., that lists on its website aahcp.org doctors and other providers, like nurse-practitioners and physician assistants, who make house calls. "Often it's a son or daughter-in-law trying to find care for a parent in another part of the country," she says. "Other times it's the spouse of someone who needs care, and they are unable to find it. The stories are heartbreaking."
Row estimates there are 1,000 full-time house-call practices in the U.S. The doctors typically have a background in internal or family medicine, but other specialties, like geriatrics and emergency-room care, are also represented. Many of the physicians are in small practices. But a few are part of large practices, like New York City's Mount Sinai Visiting Doctors Program, with 11 doctors and a support staff of nurse-practitioners, nurses, social workers and administrative assistants.