The future of house calls

Although house calls remain a part of family medicine residency training, the proportion of family physicians who perform them in practice has been declining for years. One notable exception is Steven Landers, MD, MPH, medical director of the Cleveland Clinic Home Health Agency. In previous commentaries published in the Annals of Family Medicine and JAMA, Dr. Landers has called home care "a key to the future of family medicine" and "the other medical home," distinct from office-centric Patient-Centered Medical Home initiatives supported by the American Academy of Family Physicians and other primary care groups.

American Medical News recently reported that the 2010 health reform law gave house calls a boost by mandating "Independence at Home," a Medicare demonstration project that will offer financial incentives to primary care teams performing house calls in selected high-cost areas of the U.S. starting in 2012. A similar program sponsored by the HealthCare Partners Medical Group in California, Nevada, and Florida led to a 20 percent drop in hospital use over its two years of existence, saving $2 million per year for every 1,000 members.

In addition to reductions in hospitalizations and costs, house calls produce other benefits for clinicians and patients, including improved continuity of care and new patient referrals, as family physician Samantha Pozner, MD argued in a 2003 article published in Family Practice Management.

As house calls appear poised to make a comeback, the April 15th issue of AFP delivers a timely, updated review of their effectiveness, essential elements (including a sample house call checklist), and practice management details such as current billing codes for house calls and domiciliary care.