Home-Based Primary Care: What was old is new again

Medicine changed in the 1950s and 1960s from home-based care to office-based care. The change came as technology changed and Physicians needed and wanted more complex biological data that could only be furnished by large, non-portable machinery. However, technology has again changed and is one of the reasons a new trend in medicine is taking hold. Small portable machines are now providing the data needed for providers to make medical decision, which is creating a rise in home-based primary care.
Home-based primary care is exactly what it sounds like, primary care delivered in the home. In most cases the patients use their insurance (including Medicare) to pay for the service just like they would an office-based visit. The same deductibles and co-pays generally apply. Home-based primary care is typically a full-service practice with the ability to perform blood tests, urine tests, x-rays, EKGs, ultra-sound and even echocardiograms all done in the patient’s home. This ability to diagnose and treat the patient at home is the most important piece of effective home-based primary care. This keeps the patient from having to needlessly access care in high cost, and sometimes, due to their specific and unique care needs, unsafe settings, such as the emergency room or hospital.
Home-Based primary care typically operates as a “micro practice”. This means a small number of patients (120-180) assigned to one primary care provider. This allows the provider to develop a close relationship with the patient, the family and caregivers. This relationship building improves trust, which improves provider capabilities and patient outcomes. This improved relationship and confidence also reduces anxious 911 calls and unnecessary trips to the ER.
Home-Based primary care typically cares for the small percentage of patients (7-10%) that use the majority of the Medicare resources (65%). These very sick, frail elderly and/or disabled patients require frequent visits and a great deal of care coordination to keep them healthy and independent. The VA has studied their own home based program and although the cost of primary care increased by more than 100%, the overall cost of care was reduced by 25%.