Medical House Calls May Make a Comeback

" The medical house call might be making a comeback. It was not too long ago when such a house call with standard practice for doctors they leave their office make the rounds at homes of sick patients. That's service is all but disappeared although there are several programs out there that still -- house call including a decade old program here in San Francisco. Recently bought the house and senate versions of health care reform bill. Include language that would look at home based care options as a way to cut down on emergency room visits so for more of the story we're joined KCBS news line now by Constance -- She is the executive director home care physicians and nationally recognized house call program for the homebound. Thank you so much for the time this afternoon let's talk if you would mind about the history of the house call we used to be a popular service what happened to it."

" Well it it it vanished along -- and other things that went with the year. General family practice com. It would replaced by its specialty of antley is ambulatory care and big ambulatory care facilities and they concentration in diagnostic. Saying -- in those big buildings and and though it's basically. Banished. What has made it come back now is that. There are increasing numbers particularly in its frail elderly that's the largest. They did people over eighty are the largest growing segment the the population. And those people are often home limited by the year multiple chronic conditions and functional limitations in that they cannot. Yet to physician offices. And as a result and up getting very very sick and going to the ER and ending up at hospitals -- if they had adequate primary owner in their homes. They would not have had to do that that's actually what his in the biggest single driver of the change."

" So talk about your operation how it works because it those big machines are such a big part of their doctors visited seems."

" Well the first about this is a membership organization -- the American academy compared to patients that what I'm talking about. -- our member. Is our member practices. Did a good news is that technology has made bringing everything that is in a -- a primary care physicians office. Into the home. There is their local everything there's there's there's their mobile there -- there's something called the I adapted that's. Brings mobile lab capability into the home. And all of the diagnostics things are our miniaturized there's mobile X ray everything can be done. In -- is normally in a physician the primary care physicians officers associated in the home and they're even -- them. Former ER doctors to do things that are more advance the math with a miniature sized equipment is available throughout. Especially there isn't any reason not to anymore because the technology. And that's been one of the things that had been in an enabler of the Dr. That that the black bag. Four four at the house call doctor -- days usually laptop back. But it's little pockets for instance hand and that of miniaturized equipment."

" Talk you wouldn't mind about cost there's a program here in San Francisco at the university of the California San Francisco it's called the house calls program. It reportedly operates on an annual budget of 300000 dollars all of almost all of which is devoted to salaries for the positions is there anything about the cost of house calls that might make you might make them something hard for other programs institute."

" Well. That did the answer is is to know in general but but but there are some caveats there first of all. Most top -- programs are supported by. That they operate are focused on the frail elderly and are. Build under the positioned these official and Medicare. And -- positions -- schedule is they revenues support for most leave for most of these programs. Now that revenue support is to. Unfortunately does not cover the full cost full operating cost of the program. But it's not the case that most of these practices are not to. In salary settings like academic settings vary in private practice to achieve peace there are for example and everything we -- In addition to the UCSF program he has two other members who are doing that on a private practice basis. In San Francisco and in another -- in Oakland as a as an example so. Now there's nothing there's nothing unusual about house calls in terms. Perhaps reimbursement obviously because which -- talking about. His positions and in the end usually at these programs ago -- that nurse practitioners working with physicians sometimes PA's well. The largest single continent obviously going to be. It's going to be. Employees or or salaries or. Or personnel costs."