Is there a Doctor in the House? The Return of the House Call

AUG 10

As care delivery methods continue to evolve and diversify in an increasingly consumer-directed healthcare ecosystem, the house call is making a comeback. An American Academy of Family Physicians (AAFP) article notes that physician house calls comprised 40% of medical visits in the 1930s but this number drastically declined to a meager 1% by the 1980s. The house call now resurfaces with the aid of modern technology as smartphone apps and mobile-medical technology breathe life into this once seemingly antiquated practice. It begs the question, what exactly is fueling a heightened demand for physician house calls, and what is its outlook amidst anticipated healthcare developments and trends?

Several players have entered this arena of care delivery to satisfy consumer requests for more convenient care. Apps such as HealPagerMedicast, and Dispatch Health allow patients to request care to their doorsteps within hours. These types of services are currently available scattered throughout the U.S., with most of them concentrated in metropolitan regions. Together, these companies offer uninsured care ranging from the administration of flu shots to the treatment of more serious injuries. The recent development and evolution of these businesses indicate that consumers are prioritizing the following:

  • On-Demand Care: The consumer thirst for instant gratification is evident in healthcare with consumers’ interest in on-demand care. Pager, created by a co-founder of Uber, serves the New York City area with its location-based app structured similar to Uber that allows consumers to request the fastest care provider near them. This on-demand care is valuable to those with hectic lifestyles who cannot afford to wait weeks for an appointment.
  • Accessibility and Comfort: Consumers also find treatment administered in the privacy and comfort of their own home to be increasingly appealing. This especially benefits parents with sick children, a strong segment of Pager’s user base, who would prefer to have their children stationary and comfortable while receiving treatment. House visits are just one of the manifestations of the general movement towards patient-centric care.

Despite generally positive reviews from patients using house call services, concerns have been raised that convenience-based care comes at the expense of quality. Critics question how doctors can maintain consistency in the quality of care they provide if they are delivering care in different environments. Dr. Robert Wergin, president of the AAFP, expresses his apprehension that on-call house visits fragment care and can negatively affect treatment for those living with chronic conditions as treatment is best when it is consistently administered by a single provider.

Merits and drawbacks of the house call revival aside, there are various developments within the healthcare ecosystem that could potentially either proliferate or curtail the growth of the modern house call.

  • The Affordable Care Act and an Aging Population: As legislation pushes healthcare towards value-based care, house calls are well-positioned to deliver necessary care while cutting costs, especially in treatments for the elderly. The Independence at Home Demonstration established under the Affordable Care Act provides chronically-ill Medicare beneficiaries with in-home primary care. The Centers for Medicare and Medicaid Services released that this payment model saved more than $25 million in its first year. Federal support for house calls coupled with the anticipated aging demographic could lead to the customization of house visits toward the elderly and for its demand to skyrocket.
  • Supply of Doctors: The Association of American Medical Colleges expects a shortage of more than 90,000 physicians by 2025. Although house calls may be more convenient, they are significantly less time-efficient for care providers. With this impending shortage, the capacity to meet a growing demand for in-home care may be far from feasible.
  • Costly Emergency Room Fees: There is an immense potential for consumers to save significantly if they utilize services like Dispatch Health over visiting an emergency room for many circumstances. A Wall Street Journal article juxtaposes the cost of a service like Dispatch Health that would cost between $200 and $300 against the cost of a trip to the ER which typically costs over $3,000. Dispatch Health has already treated over four hundred 911 callers that would have otherwise paid the price to go to the ER.

TripleTree is eager to observe the revival and development of the house call as it claims its spot in the care-delivery continuum. Let us know what you think.

Annie Paul
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