Cape HouseCalls program canceled

Sept. 14--A much-touted physician house calls program operated by HopeHealth is closing in a month, forcing about 200 homebound patients on Cape Cod to find new primary care providers.

Calling home care a "terrific concept," HopeHealth CEO Diana Franchitto said the HouseCalls program that started in 2012 and expanded last year was hampered by a shortage of primary care physicians as well as inadequate insurance reimbursement.

"The reimbursement model we are currently in does not even begin to cover the cost of care," Franchitto said, calling HouseCalls financially unsustainable.

The HopeHealth HouseCalls office in Falmouth last month provided patients with a list of physicians and nurse practitioners accepting new patients.

But HouseCalls patient Dorothy Vance of Centerville said the program is leaving some of the Cape's most frail individuals in the lurch.

"It's designed for people who were having trouble getting health care because they can't get to the doctor's," Vance said last week.

Both Vance, who relies on a wheelchair to get around, and her 90-year-old mother, who has dementia, are HouseCalls patients.

"Why are they closing?" Vance said, questioning whether HopeHealth's recent merger with an organization based in Rhode Island led to the cutting of the physician house calls program.

In March of 2015 Hope HouseCalls officials announced they had added two new physicians and a new care management service "to address the growing demand" for its three-year-old program of providing primary care home visits.

In October, when HopeHealth announced its partnership with Home Care & Hospice of New England in October, Franchitto -- who is based in Providence -- called the merger an opportunity for growth.

But on Friday, Franchitto said the numbers for the primary care visitation program weren't adding up.

Medicare -- which covers many of the older patients -- reimburses home visits at a similar rate to office visits, without taking into consideration physician travel time and the fact that home visits often last longer, Franchitto said.

While an office-based primary care physician can see more than a dozen patients a day, the most home care visits possible in a day is seven to eight, Franchitto said.

A shortage of primary care physicians has also made it difficult to provide continuity of care to homebound patients, she said. HopeHealth serves a little over 200 homebound primary care patients on the Cape, and another 200 off-Cape, Franchitto said.

Sixty percent of the patients are in congregate living centers such as assisted living centers, all of which have been notified of the program closing, Franchitto said.

HouseCalls employed three part-time physicians and one full-time medical director who recently moved to Western Massachusetts, Franchitto said. In addition, she said, the office in Falmouth has five staff members, including two nurses.

Most of the part-time doctors already have identified where they want to go next, Franchitto said.

Vance received a letter from HouseCalls dated Aug. 15 that includes a list of primary care providers, but it's a struggle to find a new physician -- especially for patients who want home visits, she said.

HouseCalls says two of the groups on the list -- Ideal Health Care Solutions, an Easton-based nurse practitioner group, and Outer Cape Health Services -- also do in-home visits.

"We called every one of them and they are willing to take on new patients," Franchitto said.

There are no physicians listed as making house calls to the mid-Cape, said Vance, who said that as a nonprofit organization, HopeHealth should do more to keep its HouseCalls program running.

HopeHealth's decision to disband HouseCalls comes as the federal government is seeking to expand primary care home services in the hope of reducing unnecessary hospitalizations and reducing costs.

An analysis by the Centers for Medicare & Medicaid Services released last month found that the 15 practices in a model demonstration saved more than $10 million, or about $1,010 per patient, during year two of the five-year demonstration, which ends next year.

Boston Medical Center's decades-old home visitation program is the only one in Massachusetts to participate in the federal demonstration.

Having doctors and nurses make house calls is not as cost-efficient as seeing patients in the office, said Catherine Fabrizi, nurse case manager at the center and director of nursing for geriatrics. But home visits ensure that frail and elderly patients who might not otherwise make it to the doctor's office get health care, Fabrizi said.

The home care practices that perform best seem to be those attached to large organizations with a heavy patient caseload, Fabrizi said.

"Some of our nursing salaries are paid by the hospital," she said.

The doctors enjoy home care visits, too, said Dr. Won Lee, geriatrician and lead physician of Boston Medical Center's Independence at Home program.

"It's less harried and less rushed," she said. "It's a very intimate setting."

Doctors -- and the fourth year Boston Medical Center medical students who rotate through the primary care home visitation program -- get a better picture of the patients' lives by seeing them in their own surroundings, often meeting family and loved ones.

"It's a unique experience," Lee said.

HopeHealth plans to replace its primary care visitation program next year with a palliative care program to ease the pain and stress of serious illness, Franchitto said.

The palliative care program is more in line with HopeHealth's long-time hospice mission, which is continuing, she said. For 30 years, HopeHealth was known as Hospice and Palliative Care of Cape Cod, changing to its new name in 2012 before announcing a merger with the Rhode Island organization last year.

In 2010, the then-Cape-based organization merged with Alzheimer's Services of Cape Cod & the Islands and extended its reach to the Boston area.

HouseCalls patients looking for a physician can consult Cape Cod Healthcare's access line (877-227-3262 or [email protected]), said Robin Lord, spokeswoman for Cape Cod Healthcare.

"We stand ready to ensure that the patients affected by the HopeHealth decision have access to quality primary care services going forward," Lord wrote in an email.

-- Follow Cynthia McCormick on Twitter: @Cmccormickcct

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