committed to delivering primary care as it was intended--through trust, openness, and investing in the doctor-patient relationship.

The Home Visit: Bringing It Back

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Yesterday I did a home visit for one of my long time patients that recently got discharged from a Skilled Nursing facility. She has a very complex medical history and has been in and out of hospitals and rehab facilities over the past few years. She is frail and elderly and getting to her dialysis sessions three times a week takes a lot of energy out of her. So why is it necessary for her to expend a lot of energy and experience pain to physically come in for a visit to see me? The answer is it’s not anymore.

See… in the current medical system doctors and nurse practitioners only get reimbursed by 3rd party payers if the patient physically comes in and meets with the doctor face to face. The doctor sees a complex patient like mine for 10-15 minutes if lucky (or if longer end up an hour behind), and then spends a majority of time documenting and coding the visit in order to get paid. Sounds great for the patient and doctor huh? Not exactly. It doesn’t work and it makes no sense.

So that brings me to yesterday.  Since I no longer have to see 20-25 patients a day like a machine, I now have control over how I practice medicine and the type of care I provide. By contracting solely with the patient, I can drive 2 minutes to my patient and see her at her home. I spent 70 minutes with her and her children. We reviewed her discharge paperwork, her multiple medications (trying to taper her off a few), and discussed any current issues or concerns they had. I then wrote a brief note documenting the plan and emailed the specialists involved with her care to update them as well. The focus was and is solely on THE PATIENT. All of her and her families questions were answered and we have a solid plan in place to prevent her from ending up back in the hospital- a place she dreads and I don’t blame her. Now we can work as a team to be proactive rather than reactive. We can work towards solid pain management, reduce unnecessary medications and testing, and keep her home where she is safer and more comfortable. Her quality of life is significantly better because her care is better.

And what did I receive in return? A great deal more than $30 or her monthly fee of $125.  After 8 years of caring for this woman I got to see her in her ideal setting- her home. I got to learn about the little toy animals she keeps as her hobby. I saw her family in action taking car of her and making her quality of life the best possible. Carpets have been removed so she doesn’t trip with her walker. She has a bell so she can ring in the middle of the night if she is in pain or needs something. And now she has her physician capable of coming to her and spending over an hour with her to make sure she is heard and cared for with dignity. So I got a lot more….I got to be a doctor. Not a bad value proposition for the two core people that make medicine tick- the patient and their doctor.