Printed on: March 04, 2013

New business brings health care back to the home

AUDREY DUTTON
The Idaho Statesman

BOISE, Idaho (AP) - Bill Enger waited patiently on a recent afternoon to see his doctor. Instead of sitting in a waiting room at an office park somewhere in Boise, though, Enger relaxed on his couch with his pug, Molly, by his side.

The 73-year-old retiree's physician visits him in his retirement community, as part of a new operation called House Calls.

"It's such a relief to know he is going to be here every two weeks to see me," Enger said.

A longtime critical-care doctor, Steven Fuller, and a professor of health sciences, Uwe Reischl, co-founded the company. They started partnering with a Boise-area physician, Dr. Arthur C. Jones IV, who saw their first patients last fall.

House Calls also has a second doctor, Tricia Keefe, ready to see patients when it expands to Canyon County.

Fuller said the company's vision is to remove some of the financial concerns that keep doctors from staffing nursing homes and some of the practical hurdles that make going to the doctor a daylong project for patients in retirement communities and those with disabilities.

The model is this: An assisted-living or retirement community pays a fee of $300 to $1,500 a month to the company. In exchange, House Calls arranges for a doctor to provide primary care to residents regularly. The company takes care of the doctor's back-office administration, scheduling and insurance work.

Fuller, still a licensed physician, meets with patients before their appointments so that he can take vital signs and handle other work that Jones normally would pay an assistant or nurse to do.

The patient's insurance then pays the doctor for the visit. House Calls and the doctor don't pay each other.

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It's not unheard of for doctors to visit nursing homes. But the quality of care "remains inconsistent and in many respects suboptimal," researchers wrote in a scholarly article in the Annals of Internal Medicine four years ago.

The researchers found that doctors are discouraged by perceptions - "often rooted in reality," the article said - that working in nursing homes comes with too many rules, too much paperwork, too much liability and not enough nursing support.

"Nursing home practice is only 4 percent of work time among the 20 percent of physicians who practice in a nursing home," they wrote. Doctors face "logistic challenges (for example, caring for a sufficient number of patients while traveling from one facility to another), even though reimbursement for nursing home visits has increased."

Unless they're salaried medical directors, they can't justify working in nursing homes, the researchers said.

Many retirement homes aren't sure they can afford the House Calls service, Fuller said.

Enger's home, Heatherwood Retirement Community, was one of the first visits for the company. Fuller brought Jones there last fall, but Heatherwood has decided not to hire House Calls and pay the fee. Its executive director, Joan Ziebell, said residents who benefit from the service should be the ones paying.

Fuller and Jones still see residents there about twice a month anyway, because Fuller said he feels an obligation to the residents.

Ziebell said Fuller's attention to residents, including a free blood pressure clinic, is "a really valuable thing."

Fuller can't walk through the hallways of Heatherwood without stopping to chat with a resident.

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Mark Phelan, a registered nurse who owns Applewood Assisted Living and Park Center Assisted Living, said paying a business to provide primary care is paying off in saved time.

Many of his residents have dementia and memory problems, so they get anxious or confused in a new environment such as a doctor's office.

"Families are very pleased," Phelan said. "This is something I've wanted to do for years and never could get it, because it's not cost-effective for most physicians to come out and see four or five people and spend their day here."

The benefit to Phelan is not having to deal with 17 or 18 physicians. (Most of his residents have switched to Jones as their primary care doctor, and he suspects the others will join in time.)

Since he started the homes in 2004, Phelan has grown accustomed to faxing a doctor's office three or four times a day before he can get a doctor's order changed. He prefers calling Fuller or Jones and getting a quick response.

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George Baker, 68, had his second appointment with Jones at Heatherwood last week. A Brooklyn native, Baker said the service reminds him of when he was a child and a doctor came to the house to see his grandparents.

Baker said it isn't easy for him to travel, since he's had a partial stroke, is blind in one eye and has other medical issues. That's true of his neighbors, too.

"It takes three of us to load someone on the bus," he said.

Visiting a patient's home allows a doctor to see living conditions, companions and whether the patient is overloaded with a closet full of medications, for example.

"It's kind of nice for variety's sake to come out and do something different," Jones said.

What makes it efficient for him, though, is relying on House Calls to deal with the overhead worries and on Fuller to be a medical and administrative Swiss army knife so that he can do his job - being a primary care doctor - for people who really need it.