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Housecalls: A Viable Option to Reach Patients

Explore the value of house calls for patients in San Diego County through a case study presentation by Dr. James F. Brinkman. Learn about the challenges and benefits of this approach, its relevance in today's medical landscape, and the necessary resources and technology. Discover who can benefit from housecalls, including the homebound, frail elderly, and acutely ill. Understand the model, team structure, and resources needed to implement successful house call services for Medicare-covered patients.

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Housecalls: A Viable Option to Reach Patients

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  1. Housecalls: A Viable Option to Reach Patients Long Term Care Integration Project Aging & Independence Services San Diego County James F. Brinkman, MD Housecalls: A Viable Option to Reach Patients

  2. Presentation • Who, what, why, where, and how… • Case Study • Challenges • Invitation Housecalls: A Viable Option to Reach Patients

  3. What I Am Not… • A Pioneer • An M.B.A. • A Financial Wizard • An Expert? Housecalls: A Viable Option to Reach Patients

  4. Who I Am… • Family Physician • M.C.O./The Toledo Hospital • US Navy • A-Z • Member, American Academy of Home Care Physicians Housecalls: A Viable Option to Reach Patients

  5. Why I’m Here… • Medicine’s Trends • Medical Economics 11/5/04 Issue • Less Money • More Regulation • Less Control… Catch 22 Housecalls: A Viable Option to Reach Patients

  6. Why… • Burnout &/or Insight? Housecalls: A Viable Option to Reach Patients

  7. Why… • Less Patient-Centric • Physician’s Offices • Hospitals • Managed Care • The Aging of America • Access to Care = 911 Housecalls: A Viable Option to Reach Patients

  8. Where… • Patient’s Homes • From RSF to shacks • Assisted Living • From where they beg to go… to where they beg to leave • SNF’s • A different world Housecalls: A Viable Option to Reach Patients

  9. Where Not… • Hospitals? • The Very Rural? • Unsafe Neighborhoods? • A Replacement for 911? • NOT!!! Housecalls: A Viable Option to Reach Patients

  10. How… • The Black Bag • POS Technology • The ‘Office’ Housecalls: A Viable Option to Reach Patients

  11. The Black Bag • Standard Diagnostic Equipment • Pulse Oximeter • Injectables • NTG • TransDerm Scopalamine • Trays/Dressings/Suture Material • Foley Catheters/FemCaths Housecalls: A Viable Option to Reach Patients

  12. The Black Bag (Cont.) • Venipuncture (Arterial) Supplies • Syringes/Needles • Hemoccults • Saline • Betadine/Lidocaine/K-Y/Bacitracin • Ear Lavage Housecalls: A Viable Option to Reach Patients

  13. The Black Bag (Cont.) • Anoscopy/Headlamp • Sharps Container • Gloves: Sterile & Non-Sterile • Batteries • Nail Nippers • Trauma Scissors Housecalls: A Viable Option to Reach Patients

  14. The Black Bag (Cont.) • Cell Phone • Camera • Digital preferred • Organizer/PDA • Small References • Treo 600 SmartPhone Housecalls: A Viable Option to Reach Patients

  15. The Black Bag (Cont.) • Charts • Forms • EMR…. Housecalls: A Viable Option to Reach Patients

  16. POS Technology • Multistix 10 SG • Histofreezer Housecalls: A Viable Option to Reach Patients

  17. POS Technology • ECG (midmarkdiagnostics.com) • Holter (midmarkdiagnostics.com) • PFT (midmarkdiagnostics.com) • ICG (bioz.com) • iSTAT PCA (iSTAT.com) Housecalls: A Viable Option to Reach Patients

  18. POS Technology • Biosite (www.biosite.com) Housecalls: A Viable Option to Reach Patients

  19. The ‘Office’ • Computer/Laser Printer • Fax • Scanner • Phone • Shredder • Centrifuge (LabCorp) Housecalls: A Viable Option to Reach Patients

  20. The ‘Office’ • Supplies • Coding • Billing • Virtual Receptionist • AccessLine.com Housecalls: A Viable Option to Reach Patients

  21. Who Needs Housecalls? • Anyone! • Homebound • Frail Elderly • Acutely ill • Disabled • Bedbound Housecalls: A Viable Option to Reach Patients

  22. Who Needs Housecalls? • Recently Discharged from Hospital or SNF, and unable to get in to see their physician • Prevent ‘Bounce-backs’ Housecalls: A Viable Option to Reach Patients

  23. My Model • Solo • No ‘Tech’ • Professional Corp. (S Corp) • Collaborate with PCP’s • Collaborate with Hospitalists/Specialists • Soon to add Mid-Level Providers • PA’s • NP’s Housecalls: A Viable Option to Reach Patients

  24. Team/Resources • Medicare-Covered • ***IF APPROVED*** • NOT Medicare-Covered Housecalls: A Viable Option to Reach Patients

  25. Team: MC-Covered • Home Health/Hospice Agencies • RN/LVN • PT/OT/ST • CHHA • MSW • Dietitian • Chaplains/Volunteers Housecalls: A Viable Option to Reach Patients

  26. Team: MC-Covered • Oxygen/Respiratory Support DME • Pacific Pulm. Svcs. • Nocturnal Oximetry • Oxygen • Nebulizers • Progressive Medical • Cough Assist • Ventilators • TXP Housecalls: A Viable Option to Reach Patients

  27. Team: MC-Covered • Radiology • Mobile • BioPath • Non-Mobile • Ultrasound (CVT) • Echo • Abdominal • Extremity, (A&V) Housecalls: A Viable Option to Reach Patients

  28. Team: MC-Covered • Pharmacy • Delivery vs. Pick-up vs. Mail-Order • Compounding • IV: Option Care • Resp: MedMart Housecalls: A Viable Option to Reach Patients

  29. Team: MC-Covered • DME • Beds, including home Clinitron® • Air-Mattress Overlays • Commodes • Walkers/Canes • Scooters • Trapezes Housecalls: A Viable Option to Reach Patients

  30. Team: MC-Covered • DME • Suction • IV Pumps • Nutrition Pumps Housecalls: A Viable Option to Reach Patients

  31. Team: MC-Covered • Ambulance • AMR • Balboa Housecalls: A Viable Option to Reach Patients

  32. Team: NON-MC-Covered • Patient • CG’s/Spouses/Family • Case/Care Managers • Elder Care Attorneys • Fiduciaries/Conservators • DPOAHC’s Housecalls: A Viable Option to Reach Patients

  33. Team: NON-MC-Covered • Community-Based Organizations • APS/Senior Team • IHHS • Meals-On-Wheels • Police/Fire/Rescue Personnel • Lifeline®/SafeReturn® • Medical Alert Bracelets • Companion Canines Housecalls: A Viable Option to Reach Patients

  34. Team: NON-MC-Covered • Marcia • The Great Physician Housecalls: A Viable Option to Reach Patients

  35. Case Studies • W.B. • 80 yo WF • Bedbound since 1991 s/p Laminectomy, post-op Cord Hematoma caused paraplegia • 1 mo. Later: Hemorrhagic CVA, had craniotomy; resulting L. Spastic Hemiplegia Housecalls: A Viable Option to Reach Patients

  36. Case Studies • W.B. • HTN • Dementia • Cardiomyopathy • Chronic Pain • DJD • Spasms • RSD • Neurogenic Bladder Housecalls: A Viable Option to Reach Patients

  37. Case Studies • W.B. • Chronic Tinea Pedis • Cellulitis • Hx. Urosepsis • Hx. Decubiti • Chronic Constipation • Requires digital extraction q 3-4d Housecalls: A Viable Option to Reach Patients

  38. Case Studies • W.B. • Lives in SFD • 24/7 CG • HH • Foley • Air-Mattress Overlay Housecalls: A Viable Option to Reach Patients

  39. Case Studies • W.B. • Avoided ED Visits & Hospitalizations for… • Urosepsis • CHF • Impactions • Clogged Foleys Housecalls: A Viable Option to Reach Patients

  40. My Role… • PCP = Quarterback • Call & Run the plays • Rely on my Front Line • Sometimes I Pass or Handoff the Ball • Sometimes I Run the Ball • Most of the time… We Score! • Rarely, We Punt. Housecalls: A Viable Option to Reach Patients

  41. Role of The Physician/Provider • Member of Interdisciplinary Team, not above it • Assess, Treat, Prescribe, Certify and Monitor Home Visits and Care • Care Plan Development and Oversight • Evaluate Quality of Care Housecalls: A Viable Option to Reach Patients

  42. Role of The Physician/Provider • Communicate and Coordinate • With Patient • With Family • With Care Manager and the Multitude of other Team Players Housecalls: A Viable Option to Reach Patients

  43. My Goals… • As long as it’s feasible and appropriate… • To keep patients at home • To keep patients out of the ED & hospital • To keep patients as independent as possible • To keep the family together • To rally as many resources as I can to help accomplish that • To provide compassionate, thorough, dignified care Housecalls: A Viable Option to Reach Patients

  44. My Goals… • Recognize that sometimes it’s… • Not Feasible • Not Appropriate Housecalls: A Viable Option to Reach Patients

  45. Benefits Of Medical Housecalls • Improved Access to Care • Prevent Unnecessary Hospitalizations • Prevent Unnecessary ED Visits • Improved Health Outcomes • Improved Quality of Life Housecalls: A Viable Option to Reach Patients

  46. Benefits Of Medical Housecalls • High Patient Satisfaction • Regardless of age, surveys indicate Pts. prefer to be cared for in the home • More comfortable in their own home • More likely to be compliant Housecalls: A Viable Option to Reach Patients

  47. Benefits Of Medical Housecalls • High Family Satisfaction • Reduced Stress! • Improved Logisitics • Less time lost from work/job Housecalls: A Viable Option to Reach Patients

  48. Benefits Of Medical Housecalls • Cost-effective vs. repeated ED Visits and Hospitalizations • Technology allows far more POS diagnosis and procedures than previously available Housecalls: A Viable Option to Reach Patients

  49. Challenges & Barriers • Managed Care • Medicare • Medi-Cal • 3rd Party Payors Housecalls: A Viable Option to Reach Patients

  50. Challenges & Barriers • Malpractice • Declining Reimbursements • Increasing Expenditures • Increasing Federal, State, and Local Regulation Housecalls: A Viable Option to Reach Patients

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