A return to the doctor's house call may aid health care reform

Dr. Peter Boling provides house calls for some of Richmond's oldest and sickest patients as a geriatrician and head of general medicine at Virginia Commonwealth University Medical Center. The Associated Press/Richmond Times Dispatch  reports that "he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma. ... Boling wants to bring house calls to the masses — up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost-savings, but to provide a financial incentive to persuade more doctors to return to this kind of work. It's also about improving access and providing patients the independence they so desire."

Boling sees the house call as an important way to care for patients with multiple chronic conditions, who account for almost two-thirds of Medicare, and "envisions [such patients] being cared for under the proposal now pending in Congress. The so-called 'Independence at Home' provision is but one small piece of the comprehensive health care reform measures being debated in the House and Senate." It has drawn support from both Republicans and Democrats alike. "Perhaps because it targets the bane of the health care system: a Medicare program on the verge of insolvency and the small percentage of patients who account for the bulk of the program's costs. ... The provision calls for the Medicare program to partner with home-based primary care teams like Boling's for a pilot project to test whether house calls would reduce preventable hospitalizations and readmissions, ER visits and duplicative diagnostic tests for high-cost, chronically ill patients" (Arrillaga, 10/31).