Making House Calls, But for How Long?

In-home visits by a few physicians to the elderly & severely disabled may fall victim to Medicare cuts


Rosanna Ruiz | | Thursday, November 1, 2007

Correction: Sarah Slusher was in a car crash on Jan. 15, 2006, and was discharged from a hospital in April that year. The date of the crash was incorrect in this story.

HOUSTON, Texas-- The black leather medical bag he carries completes the anachronistic image of a physician who makes house calls.

Dr. Darcey G. Kobs III, like the country doctors of old, knows his patients by name and doesn t rush through his exams. More importantly, he gives his patients the medical care they would otherwise do without. He s one of a half-dozen doctors and physician assistants in the Houston area who make their living through in-home visits.

House Call Doctors Texas, a group similar to the Visiting Physicians Association, started here and in Austin in 2000 with plans to expand to Dallas and El Paso. About 1,000 patients in the Houston area are now being served with about 30 new ones signing up each week, said Bob Buckholtz, a spokesman for the group.

While many of their patients are bed-bound and elderly, more able-bodied clients are also accepted.

One patient, Sarah Slusher, 22, has been in a coma since an April 2006 (SEE CORRECTION) car crash. Kobs has regularly visited her bedside in southwest Houston for the past year. If not for him, Slusher would have to rely on an ambulance to get to her regular checkups.

It s such a blessing, said Kaye Slusher, Sarah s mother.

While the number of physicians willing to make house calls has grown slightly since Medicare increased reimbursements in 1998, pending cuts may reverse the trend. The potential program cuts also come at a critical time now that baby boomers are Medicare eligible, said Constance Row, executive director of the American Academy of Home Care Physicians.

We are calling this service an endangered species for Medicare patients, Row said. People who do not have backup insurance are going to be particularly hard hit. Physicians cannot provide on Medicare reimbursements alone now and the situation will become even more severe.

Row, and those associated with House Call Doctors, insist that these types of preventative health care services actually save millions in annual Medicare costs.

Earlier this week, Kobs made the rounds at a southwest Houston assisted-living facility where he found one resident s heart racing. The man was severely dehydrated, Kobs concluded, after the resident explained he had been suffering from a virus.

Drink lots of fluid, Kobs told him, even if you don t feel like it. That s the only thing that will keep you out of the emergency room.

Paula Schurman, general manager of Hearthstone Assisted Living, said Kobs visits relieve relatives of the burden of getting their loved ones to frequent medical appointments. There is no physician on duty at the facility.

It s a wonderful concept and it s become a godsend, Schurman said.

Kobs, who followed in his physician father s footsteps, said he prefers this brand of medicine rather than being tied to an office-based practice.

That s pretty much my office, he said pointing to his leather bag and portfolio.

The home visits also allow the physicians to see how their patients live and what they eat. A diabetic, for example, may have a tougher time hiding the fact that they ve been consuming more sodas and sweets than they should.

While the ranks of doctors who perform house calls have steadily grown, demand continues to outpace their numbers. At least 2 million seniors who are 65 or older are considered homebound while millions more are so disabled they cannot easily access medical treatment, according to the American Academy of Home Care Physicians.

Medicare providers, such as Kobs, bill for about 1.8 million house calls a year, but given the population size of the homebound alone, the figure should stand at 10 million per year. A 10 percent cut to Medicare recipients and providers would spell ruin for many people, Row said.

This problem is going to get larger and larger, Row said. That s why we are so concerned that Congress address this issue before things get worse.

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