Some doctors think we should make more house calls to get closer to the patients and get a better understanding of how their living habits and social circumstances are affecting their health. While nostalgic and reminiscent of horse and buggy days, there are many reasons why house calls are a bad idea:
1. Money. Reimbursement rules can't sustain the model.
2. Inefficiency. With doctors under more pressure to see more patients, the work flow numbers simply don't work. Can you imagine finding a parking space in a busy metropolitan area?
3. Security. There is a threat to the security of the house-caller, particularly if there is the perception (or reality) that they are carrying controlled substances.
4. Quality of care and lack of care coordination. The assumption is that the house-caller will have access to the resources necessary to solve the patient's problem. In many instances, that might not be the case. What's more, particularly for older patients, the siblings, children, and surrogates need to know the findings and are often out of the loop.
5. Liability. Can doctors adhere to the standard of care at home versus a more traditional care facility?
6. Technology. The Internet of Things and telemedicine are making virtual house calls more of a reality and more convenient for both the patient and the house-caller. Wouldn't you rather see a hologram or an avatar?
7. Waste. A significant percentage of medical visits are unnecessary. There is little evidence to think that the same won't be true for house-calls.
8. Poor triage. Some house call patients should be seen in an urgent care facility or emergency room. In addition, the model seems most appropriate for chronic or complex care management of patients usually treated by primary care physicians. For many specialists and surgeons, it is not applicable.
9. Third party intermediary interference. Insurance payment and integrating the house call findings into an interoperable electronic medical record are but two obstacles.
10. Medical education. Medical educators are having hard enough time with reforming medical education that conforms to increasingly decentralized care that does not take place in a hospital, where most residents and medical students spend most of their time and see most of their patients.
House calls are a quaint reminder of more high-touch times. Unfortunately, they will go the way of red phone booths and pay phones. When we unbundle primary care and separate healthcare from Sick Care, then we can focus on using innovative ways to manage chronic and chronic complex care that improve the outcomes and are more efficient.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org