Dec. 03--Family nurse practitioner Susanna Payne typed on her laptop computer as she quizzed Maureen Peterson on the medications Peterson was taking.
"When's the last time you took your metolazone?" Payne asked, referring to a drug that treats high blood pressure and fluid retention.
"You were pretty swollen the last time I was here," Payne said later. She reminded Peterson of the need to watch her salt intake as she did a hands-on exam, where she noted the swelling in Peterson's left leg and foot.
Typically such an exam would take place in a medical office, but Payne handled it in the living room of the Richmond home Peterson shares with her husband and caregiver, Harry Peterson.
Mrs. Peterson, 57, who needs a wheelchair to get around, is thankful that Payne, a nurse practitioner who works for VCU Health System's House Calls program, was able to come to her.
"House Calls has been a blessing to me. It really has," Peterson said, recalling at least a couple of instances in which she missed doctor's appointments because van transportation didn't show.
The concept of medical house calls might bring to mind black-bag-carrying rural physicians. But under the modern version, the federal Medicare program is testing whether home visits can provide care of select homebound patients on par with, or beyond, office visits.
The Medicare Independence at Home initiative is funding demonstration projects in 15 individual medical practices and three group efforts across the country. The programs will voluntarily enroll up to 10,000 Medicare beneficiaries who have chronic conditions and meet other criteria. The project runs for three years.
"We will be rewarded if the patient's quality of care is maintained but their costs go down, said Dr. Peter Boling, professor of medicine and chairman of the division of geriatric medicine at Virginia Commonwealth University.
"That's what we expect. Because we will be able to get to them quickly when they start to feel bad and help them stay on a more steady path, they will spend less time in the hospital, which is safer and better for them," said Boling, a founding member of the American Academy of Home Care Physicians.
VCU has operated its House Calls program for more than two decades, and Boling, who heads the program, has championed the idea of home-based care for frail patients.
For the demonstration project, VCU is partnering with two other institutions _ the University of Pennsylvania House Calls program and MedStar Washington Hospital House Call program _ to form a consortium.
Each of the programs in the consortium has its own group of providers, but collectively they will enroll up to 500 patients.
Boling said there are three physicians making house calls and nine nurse practitioners. The program has recently added a social worker, office nurse and data analyst and will soon add another nurse practitioner.
Payne said clients typically live within 15 miles of VCU Medical Center, and she does three to five visits per day, keeping in touch with patients between visits by phone.
"Will you call me on Monday to let me know how the fluid is doing?" she asked Peterson during her visit. If everything stayed the same, she said she would be back in two weeks.
Boling said VCU's target is to enroll 150 to 200 patients. To qualify, patients must be covered by Medicare and have problems in carrying out basic activities such as dressing and using the bathroom.
If the demonstration projects are successful, it could change the Medicare program "quite dramatically and almost create a whole new field," Boling said.
"We've designed it so that lots of programs could get into this type of model without having a lot of cash and backing and changes in structure of insurance programs or other things that are barriers to entry," Boling said.
"That is one reason why so many of the advanced geriatric care models have not advanced," he added. "It costs so much and you have to have so many resources and structures in place to start programs. We wanted to avoid that, and we wanted to target these programs and design them specifically to take care of people who are very frail and old and at risk."
(c)2012 Richmond Times-Dispatch (Richmond, Va.)
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