There’s a doctor in the house

Diana Sahagun

Saturday, Nov. 25, 2000 | 3:03 a.m.

While most people cringe at the thought of visiting a doctor, 44-year-old Eleanor Crawford can barely wait to see hers.

While waiting recently for a monthly checkup, Crawford was so excited she rolled her wheelchair out to the apartment parking lot to greet her doctor as he pulled up in a bright OnCall Medicine van. She started talking to him before he could even open the van's door.

This is not a typical doctor's office visit. This is the return of the house call -- patients being treated in the comfort of their homes.

Doctors around the Las Vegas Valley are turning back the clock and reviving a century-old medical practice that gives new meaning to the phrase, "Is there a doctor in the house?"

Gone are the days when a family doctor came to homes armed only with a black medicine bag with a thermometer and stethoscope tucked inside. Today's high-tech and miniaturized equipment means health care providers can take the technology typically found in a hospital to the living room.

The tradition, a staple in the nation's health care system decades ago, is finding a market for seniors and the home-bound, because of changes in a medical system now dominated by managed care.

The trend is catching on, but medical professionals say the industry must strive to make house calls economically feasible or the majority of health care will continue to take place in a doctor's office.

Ironically, advances in technology drove the number of house calls down significantly in the 1940s, said Dr. Joanne Schwartzberg, director of aging and community health with the American Medical Association.

At that time, medicine's cutting edge treatment could only be accessed in hospitals.

But because equipment has been downsized, portable X-ray machines, EKG machines, heart monitors and ultrasound machines can now be thrown in the back of a van and taken right to the home.

Schwartzberg believes doctors are bringing back the long-standing medical tradition of house calls for a simple reason -- patient demand.

"One of the basic reasons is because we have an aging society so we have increasing numbers of people living much longer and developing chronic illnesses," she said.

Waiting until it's too late

Because many seniors and chronically ill patients are unable to travel to a doctor once a month for checkups, patients are waiting until there is an emergency or until it is too late, she said.

According to the American Academy of Home Care Physicians, there are 34 million adults over age 65 in the United States, and the number is expected to double in 20 years.

By 2020, 2 million elderly will be chronically home-bound because of an impairment.

Constance Row, executive director of the American Academy of Home Care Physicians based in Maryland, said a study found that in the 1980s only 50 percent of physicians provided house calls, and many who did provide the service did so infrequently. But in the last five years, Row said the academy has discovered more physicians offering the service, although there is no national survey on how many house calls are made each year.

To put the number into perspective, Medicare, the nation's largest health insurance provider for people age 65 and over, has been billing 1.6 million house calls each year for the last three to four years.

Doctors are offering house calls around the country from Chicago, New Jersey, Florida and California -- mainly where there are high senior populations.

Many of the house call doctors complain that the managed care system doesn't allow them to spend enough time with patients. They say a house call gives them more time to get to know the patient, leading to a more thorough diagnosis. Most doctors bill the service through private insurance companies and through Medicare and Medicaid.

Several local companies are touting success in the market, offering the home-doctor approach to medicine.

And in a city like Las Vegas where the senior population is booming, house call doctors may have found a ready market.

OnCall Medicine, a private company operating in Las Vegas since August 1999, provides house call services mainly for seniors, but also offers home visits to those who would usually go to the emergency room for a nonemergency.

The company has seen 5,000 patients since it opened.

Douglas Key, vice president of operations, said 70-75 percent of its business is seniors who are home-bound.

The company staffs two doctors and a physician's assistant or nurse practitioner each day to see 30 patients.

The physicians write prescriptions and are contracted with pharmacies that make home deliveries. The doctors can also make referrals if the condition is serious.

"We are serving a big need for a lot of families because we are seeing patients that normally would not get their routine care," Key said.

And with Clark County hospitals facing a shortage of emergency room beds, Key is hoping the company can help take up some of the slack for nonemergency visits.

On Dr. Mark Burroff's visit to see Crawford recently, he settled down in a cushy armchair before taking out his black bag filled with small equipment to begin an exam.

His assistant, Ron Peterson, quietly filled out paperwork while the doctor checked Crawford's pulse, vital signs and blood pressure. The two chatted for a half-hour about their children, puppies and problems with modern health care.

"You're getting high blood pressure," he told Crawford. "Next time I come out we're giving you medication if it's still high."

A godsend

Crawford -- who is wheelchair-bound -- said the house call service is a godsend for people who are physically impaired. Before she found OnCall Medicine, going to a doctor's office was a frightening ordeal.

"I get to my car, get my (wheel) chair in the car, get myself in the car, get to my doctor, get the chair out of the car ... by the time I'm in to see the doctor, I'm ready to go home," she said.

"Now I don't have to deal with the front office girls, I just stay home, and all I have to concern myself with is if my house is clean," she said.

Burroff quit his job in private practice several months ago to get back to the housecall roots set down by his father and grandfather, who also were doctors.

"People feel more comfortable in their home because you're in their territory," Burroff said. "My dad always said, 'A hospital is nowhere to be when you're sick.' "

House Call Doctors has been in business locally for two years. The company employs six physicians who see approximately 60 patients per month, mostly seniors, said James Egidio, managing director.

Both house call companies bill through Medicare and Medicaid, insurance for seniors and low-income people. The cost is comparable to a visit to a quick care, or emergency room.

OnCall Medicine also has a contract with Blue Cross/Blue Shield and offers service to all Station Casinos employees.

Dr. Carey Logan, medical director for Inn-House Doctor Inc., has found a niche in the Las Vegas tourist market, where long nights and buffets often leave many looking for a doctor.

Making 'hotel calls'

The company employs eight physicians who make "hotel calls" to some of the major resorts in the city, including the Mandalay Bay, Paris, Luxor, Excalibur, Hard Rock, Aladdin and the Rio.

Some are referred to the company through the hotel's front desk, while other hotels provide their business card in the hotel rooms.

"In the past, a casino would say go to the emergency room, but for a guest to go to the ER for a nonemergency, they would wait 10-12 hours," Logan said. "It is much more time-effective for them to be seen by us within an hour."

The cost for a hotel visit can range from $150-$200.

Most house calls are currently being billed through private health insurance. Health professionals say HMOs have yet to get on the bandwagon because studies have not been concrete on how financially viable house calls can be.

"On the medical care delivery scene, we are trying to persuade (HMOs) to get involved, but it's simply a very rocky road," Row said. "The only way we know to have managed care companies pay attention is if we could show house calls were more cost-effective than having them cared for in a more traditional way."

One of the barriers in the house call scene has been education. For the last decade, Row said medical students have not been educated on house calls, and there are few materials available for teachers.

The academy, though, is working to secure grants to fund development of educational material for teachers. It also is working toward elevating reimbursement levels for doctors.

Home-care training

The AMA also is working through a Harvard University foundation to get home-care training into medical schools.

Bill Thompson, professor of public administration for the Department of Health Care Administration for UNLV, said he expects the university to begin offering house call curricula soon.

Thompson said house calls are appropriate for Las Vegas because the city is getting bigger and more and more seniors are moving into town.

"A patient in a home is a comfort zone. Some people don't like going to doctors -- me being one -- because it is an exposure to someone else's illnesses," he said.

"So many times I have heard people say, 'I go in there for 5 minutes, and the bill is $80. When you're in the home, you have their attention, and you're the only patient they're seeing."

Schwartzberg said as more patients demand the service, more insurance companies will be persuaded to take on house calls.

"It's the kind of medicine a lot of people would like to have," she said. "And we're going to make it possible somehow. Home care should be the first option, rather than going to the hospital. And we need to change our thinking to that. That should be the goal."

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