Dr. Peter Boling of the VCU Medical Center says he knows a way to provide better and less costly health care to elderly and disabled patients. His solution? House calls.
In what may be seen as an antiquated practice, he and a team of VCU physicians have been visiting Richmond patients in their homes for almost 25 years. Boling (shown above) says these regular visits help prevent health deterioration; they also lower costs by avoiding unnecessary complications and emergency-room visits. But his vision extends beyond about 275 Richmond patients who currently receive home visits. He says that 3 million high-risk, high-cost Medicare patients nationwide could be better served with a similar program. In May, Boling took his idea to Washington, where he promoted "Independence at Home" bills in the House and Senate.
"Dr. Boling would probably argue, and maybe he's right, that house calls should be part of the basic foundation of health care," says Dr. Johnny Wong, president of Pulmonary Associates of Richmond.
The legislation, introduced by Rep. Ed Markey, D-Mass., and Sen. Ron Wyden, D-Ore., resulted from a collaboration with the American Academy of Home Care Physicians. It proposes that Medicare approve as many as 50 pilot programs that would enroll 10,000 or more beneficiaries. Home-based primary-care teams would treat these patients, and the programs would be monitored to see if house calls reduce hospitalizations and readmissions. If the pilot programs are successful, the measure proposes that home visits become permanent after three years.
For many elderly and disabled patients, "it becomes more difficult to access the health-care system because it takes sometimes days of planning to organize transportation," Boling says. Patients "go into a no-care zone."
The legislation was added to the national health-care reform bills still being debated as of early December. Boling, VCU's director of geriatric programs and chairman of general medicine, says he feels confident that the Independence at Home measure stands a fighting chance. "If the health-care reform passes, we are 75 or 80 percent likely to be in there," Boling says. "If health-care reform does not pass, we have the original bills, and we will go back to those."
Wong, who is also immediate past president of the Richmond Academy of Medicine, says that while he hopes the bill passes, he is uncertain about funding for home visits. "If we had unlimited resources, I think it would be a slam-dunk," he says. "They are going to take existing resources and redistribute them. ... If we are going to create something, we have to make sure it is sustainable."
Boling says the local program, VCU House Calls, and similar national programs are not for those who just find it inconvenient to drive to the doctor — but for the intensely ill, including those with multifaceted illnesses and rare conditions.
"Most of them have five or more chronic conditions; many of them have 10," he says. These conditions include cardiovascular disease, stroke, lung disease and neurological ailments such as dementia, Parkinson's disease, Alzheimer's and even severe arthritis. Since Boling launched the program in 1984, local patients have been seen an average of once per month, but as many as four times per week if necessary. He says the home visits help ensure that medications, diets and other appropriate health precautions are being followed so healing can occur.
Jill Sumner, vice president of strategic planning and business development for UHS Managed Care Inc., a division of the VCU Health System, affirms that home care works. She partnered with Boling to develop a yearlong pilot program that worked in homes with 15 Richmond patients who had complex cases. "Having such hands-on care [enabled] them to maintain that lifestyle longer and in a much healthier, more positive way," she says.
