House calls, generally imagined as a thing of the past, are making a
comeback as Americans increasingly prefer outpatient treatment for
medical problems. The drive away from hospitals and other major medical
centers has lead to a diverse demand for registered nurses. With
increasing opportunities opening up for nurses, many have found that not
only is there a demand for house calls, but they prefer that kind of
work.
While many have tackled healthcare reform with negativity, seeking only
to derail corrective measures, many groups, particularly those involving
nurses, are trying to get ahead of healthcare overhaul by setting up
accountable care organizations. These can be either physician-run or
hospital-physician partnerships. They manage patient care in an
effective way, and are rewarded for cost saving measures. Many programs
seek to address the problem of waste in Medicare, and various
experiments are being run all across the country that should improve
care and reduce wasteful spending. In St. Petersburg, for instance, the
health insurer Humana operates a program called Humana Cares, a national
call center that connects nurses and social workers with Medicare
Advantage patients with chronic illnesses.
Dr. Gerard Anderson, director of Johns Hopkins University's Center for
Hospital Finance and Management discussed another such initiantive set
to start in 2012. "One of the major initiatives that will start in 2012
are the accountable care organizations, which hospitals and managed-care
organizations and insurers are all trying to figure out how to do," said
Anderson. "That's a fundamental change in how Medicare works and nobody
knows how it's going to play out. Even the preliminary regulations
haven't been written."
House calls are another method of addressing some healthcare problems in
America. The Orlando Sentinel highlighted one nurse, Sherry Dvorak, who
believes that there's more to house calls than just the medicine
involved. Dvorak is a home health nurse. She participates in a pilot
program that Medicare calls a "medical home," designed to keep seniors,
especially those who are chronically ill, from being repeatedly
hospitalized. In the medical home project, launched in August and run by
Metcare and SeniorBridge,is a primary-care program in which doctors
coordinate patient care with the help of non-medical staff. This program
also saves Medicare money and improves the health of seniors, because
many elderly health issues can be adequately addressed in their own
homes, but without house calls available, they must visit a hospital.
The New England Journal of Medicine recently published findings that
demonstrate that one in five seniors is rehospitalized within 30 days of
being discharged from a hospital. Metcare wants to prevent this
re-hospitalization by giving enrolled patients weekly visits from a
nurse or social worker, and the ability to contact an on-call nurse 24
hours a day. Johns Hopkins analyzed similar programs and found that for
each nurse hired, the program saved $75,000, and hospitalizations became
two-thirds less frequent.
Dvorak drives to patients homes and chats with them over coffee while
giving health exams and listening to their problems. If their problem is
serious, she picks her patients up and drives them to the doctor's
office. If they're having a bad reaction to medication, she rushes to
attend the problem. If they are having trouble reaching a pharmacy, she
makes those calls for them.
"She really lifts my spirits," said one of her patients, Joan Love, 77,
of Ormond Beach. "She has been a real godsend."
One Metcare patient, Carolyn Austin, is thankful for the program. When
she joined the pilot program, the Metcare team began addressing some
basing health issues she had. For instance, social worker Mike Ward
arranged for a new wheelchair for her because her old on had a torn
armrest that was cutting her skin and leading to recurring infections.
Her nurse, Dvorak, also got the pharmacy to provide her medication in
flip-top bottles because Austin's severe rheumatoid arthritis made
opening the traditional bottles painful and difficult. When Austin had
hip-replacement surgery and was essentially immobilized, Ward signed her
up on a a waiting list for a national organization that would provide a
ramp to her home; it was recently installed.
Dvorak has "been a big help to me," said Austin, 73, of Daytona Beach.
"I hope this works out because it's a wonderful program."
This particular program focuses on Medicare patients who do not have
relatives nearby, who have chronic conditions requiring frequent
doctors' visits, and who have confusing medications to keep track of.
The pilot program is being run in the areas of Daytona Beach, New
Smyrna, and Ormond Beach. When totally up and running, the program
expects to include 100 patients.