Doctors bring treatment back into patients' living rooms

Higher Medicare reimbursements and a yearning for personal care revive the house call.

[Times photo: Douglas Clifford] Dr. Dalton Benson checks Harold Liston's heart rate during a house call to Liston's apartment. House calls are regaining popularity.

LARGO - Dr. Dalton M. Benson, stethoscope around his neck, knocked on Harold Liston's front door and poked his head in after hearing a muffled "come in."

Liston, 94, was sitting in a mustard yellow recliner, his walker in front of him, his studio apartment dead quiet save for the ticking of a small white alarm clock on a nearby nightstand.

"How ya feeling, chief?" Benson asked, setting down a black bag hanging from his shoulder and taking a seat at an oak dinette set. His medical assistant pulled a black case on wheels across the linoleum of Liston's kitchen floor.

"Sore," Liston said, a bit despondently. Later, Liston, who has a heart valve problem that can't be fixed, said, "I wouldn't mind dying right now."

"I know, I know," Benson told his patient soothingly as he checked him over.

Benson is among a new breed of doctors that have taken their medicine on the road in recent years. All but extinct since the 1960s, the house call has resurfaced during the past decade with nearly 1.6-million visits paid for by Medicare in 2001 (the last year for which complete figures are available).

And now it is poised to become even more popular, thanks to a growing demand, higher Medicare reimbursements, and medical advances that allow doctors to take office technology to patients.

During his visit with Liston one day recently, Benson asked his assistant, Josephine Ramos, to draw blood for a thyroid test, a complete blood count and a complete metabolic profile. As Benson checked Liston's heart with a stethoscope, Ramos opened a balcony door to let some air into his stuffy apartment at a Largo retirement center.

"Is it that nice out?" Liston asked.

"It's nice out," she said. "Do you ever sit outside?"

"No, what the hell for?" the retired machinist answered.

"You need to get some fresh air," Ramos said.

Every month, Fran Lurie, 56, would help her husband into his motorized scooter and maneuver it down a ramp outside their mobile home in Largo to a transport van for the trip to the doctor.

But as his Lou Gehrig's disease got worse, John Lurie, 59, who was chief financial officer of a sign and awning company before he got sick, could no longer move the 500-pound scooter. His wife tried to manipulate the joystick, but she ended up slamming her husband into walls and doorjambs. At least once, they took off a door frame.

Two months ago, Mrs. Lurie knew she could no longer do it alone. So she told her doctor, Fadi Saba, that her husband wouldn't be coming anymore. That if he got sick, she'd just have to call for an ambulance. "It was the only way I could do it," she said.

Then she learned a doctor could come to her. Saba, who is part owner of a company called Advanced Mobile Healthcare, told her about the service it offers.

"To bring back the visiting doctor, I don't know what I'd do without it," Mrs. Lurie said.

The house call is gaining in popularity. Nationally, the Centers for Medicare and Medicaid Services paid for about 71,000 more house calls in 2001 compared with 2000. In Florida, Medicare paid for 160,565 house calls in 2001, up about 6,000 calls from the year before.

Other signs of the growth in house calls:

- The 700-member American Academy of Home Care Physicians has grown in the past couple of years from having at least one doctor in 13 states to at least one in 46 states. They are particularly popular in retirement states, such as Florida, Arizona and California.

- Not only do house call doctors have their own organization, it will hold a convention, "House Calls in the 21st Century: High Touch and High Tech," next month in Baltimore, where it will also select the "House Call Doctor of the Year."

- Some medical schools now are including the house call in their curricula.

The return of the house call can be attributed largely to a change in the way Medicare reimburses doctors. In 1998, the federal agency increased reimbursements by up to 50 percent for some house calls, said Constance Row, executive director of the American Academy of Home Care Physicians.

Doctors who make house calls might see only one-quarter of the patients of the average doctor who sees patients in the office, so the increased payout made it more financially feasible for doctors to turn to house calls, Row said.

A midlevel office visit would pay about $90 to a doctor, while a similar house visit would pay $129.

"I think some doctors know there's a need, they know people aren't getting routine primary care and they're ending up in the emergency room and the hospital," Row said. "Many see this as an opportunity to do what they were trained for originally. They do want a chance to get to know their patients. They don't like managed care. For some of them, this is a real coming home to their professional motivation."

There are at least three companies in the Tampa Bay area with full-time mobile doctors or nurse practitioners, as well as a handful of private physicians who make house calls for certain patients on the side.

One company, MD To You, has 12 physicians roaming south, central and west Florida who see more than 2,700 patients a month, and business is growing steadily, said Shannon Owens, a spokeswoman for the company. The company plans to add four physicians by year's end.

Dr. Suzette Reyes, who covers the west coast of Florida for MD To You, says she thinks the doctor house call is here to stay, as long as Medicare continues to pay for it.

"It's something we're just starting to tap into, and you can just see the need for it," she said.

Benson and Ramos work for Advanced Mobile Healthcare, a Clearwater company that has grown from 70 patients a month when it opened in December to 500 patients in March. The company is drawing an average of five new patients a day and is about to hire two more doctors to handle the demand.

These are primary care doctors, who typically travel with a medical assistant in a company vehicle, going from nursing homes and assisted living facilities to retirement communities and independent homes. They can do just about anything a doctor in an office can do from drawing blood to performing EKGs. They cater mostly to an older population who struggle to get to the doctor.

Benson was a primary care physician in Dunedin when he decided to turn to mobile medicine.

Benson says some of his new patients are shutins who have not seen a doctor in years. Others live in retirement communities and faced arduous trips to the doctor's office.

The doctor said he has seen a marked difference in his relationship with his new patients.

During a visit to Ralph Weeks, a retired sewage pump installer, at his one-bedroom apartment last week in Largo, Benson checked the 68-year-old's ears with an otoscope then laid it down atop a Verizon bill on Weeks' cluttered coffee table. Then, as he uncoiled his stethoscope to listen to Weeks' heart, he tripped over a picture leaning against the couch and learned the man in it was Weeks' grandfather. Later, he peered at a framed collage of newspaper articles about Weeks' father and asked about a life-sized picture of Pogo, Weeks' Shih Tzu, in sunglasses and bandana.

He said his patients often show him their memorabilia and it gives him a better idea of who they are and where they've been.

"I think this fills a need, which is why I choose to do it," Benson said. "I don't like working in an office setting. It's very repetitive. It's like a factory. You shuffle them in, shuffle them out every 15 minutes. It's almost artificial. I don't get the feel for the patient as when I'm in their home."

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