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The Return of the House Call

How long did you spend in the waiting room for your last visit to a doctor?  Until the 1950’s, house calls comprised forty-percent of all physician-patient encounters.[1] The tradition of house calls can be traced back thousands of years as evidenced by citations in Homer’s Iliad and Odyssey.[2] As a time honored tradition, the house call offers many benefits; however. By 1980, the concept of house calls was all but extinct with less than one percent of patient encounters occurring within the home. 

House Calls blog graph

Today we’re experiencing a resurgence in house calls by a range of medical providers ranging from technicians, nurse practitioners, and even physicians.   In 1998, Medicare’s billing procedures were modified to include reimbursement procedures for the delivery of medical services at home, and in 2010, the Affordable Care Act passed with provisions to conduct a three-year test to evaluate the possibility of decreasing the cost of healthcare delivery through the utilization of medical house calls.  Correspondingly, the in-home delivery of healthcare services has grown to a sixty-six billion dollar industry with over nearly a quarter of a million participating businesses.[3]

            A typical doctor’s black bag back in 1950 contained items like a stethoscope, thermometer and perhaps a dozen or so pharmaceuticals.[4]  Today’s healthcare provider relies upon an array of medical device technologies and thousands of pharmaceuticals to diagnose patients and deliver sophisticated treatment regimens.  Shifting millions of patient encounters from the hospital and medical office building environment creates numerous logistical challenges and requires a sophisticated supply chain which is able to provide the timely delivery, replenishment, and return of a wide range of diagnostic testing materials, medical supplies, and medical devices.

             How do you build a supply chain to support the medical house call? 

  • The critical starting point is a reliable order and delivery network in order to ensure the correct material is available to enable a successful home patient encounter. 
  • During the patient encounter, diagnostic test supplies may be needed to draw patient samples and arrangements for the transportation of time sensitive biologic substances will be needed to facilitate testing and diagnosis. 
  • Increasingly, patient treatment plans include sophisticated medical devices (i.e., infusion pumps).  These devices require accurate calibration and monitoring which creates the need for the delivery and return of these devices to providers who can ensure the device is correctly maintained and operating properly.

Time will tell whether house calls again become as prevalent as they were in Homer’s time. Treatments, happily, including those Greek favorites blood-letting and leeches, have irrevocably moved on.

What do you see as the future of the house call? 

[1] Leff, B., & Burton, J. R. (2001). The future history of home care and physician house calls in the United States. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(10), M603-M608.

[2] Beyond the House Call: Doctors in Early Byzantine History and Politics, Barry Baldwin Dumbarton Oaks Papers, Vol. 38, Symposium on Byzantine Medicine (1984), pp. 15-19

[3] IBISWorld Industry Report

[4] www.aafp.org/afp/2000/0415/p2323.html

Chart: Centers for Medicare & Medicaid Services

Category: Healthcare
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