Dr. home visits seen as preventative medicine

PITTSBURGH -- The conversation between Dr. Monica Dua and her patient, Roosevelt Copeland, covered wide terrain, including not only his physical status but the cost of his medications, the condition of his wheelchair and the size of his bed."I toss and turn a lot -- the next thing I know I was on the floor one time two months ago," the ample-sized 69-year-old told the internist from West Penn Hospital's Home Visit Program.Dua peeked in the bedroom of Copeland's apartment. Sure enough, there wasn't much room in the standard-sized hospital bed. The doctor would speak to a social worker about ordering a wider alternative for Copeland, whose physical abilities are impaired by a stroke and kidney disease, among other maladies. She intended to avoid adding fractures to his list of health problems."There is a larger-size bed," Dua noted. "I don't want you falling out of that bed again."It's the kind of proactive, preventive health assessment that would be difficult for a doctor to make in her own office. That's the value of the Home Visit Program, in which Dua sees about 15 different homebound patients each week in their own residences, supplemented by a nurse practitioner visiting a smaller number.These "surveillance" visits, as they're called, are designed to prevent minor health problems from festering and becoming the kind of serious issues that require costly hospitalization. The doctor or practitioner visits the 170 or so patients in the program every few months for about a half-hour, driven from stop to stop by a hospital employee in an SUV.Without the home visits, Dua said, "These are people who would probably just check themselves into the hospital whenever something's wrong. ... There are physicians who make a few house visits, but regular practitioners can't really do it." Dua is the only Western Pennsylvania doctor listed by the American Academy of Home Care Physicians, which has a membership of about 1,000 health care professionals involved in patient care at home. On a recent morning, Dua and Dr. Ian Seemungal, a third-year resident, followed Copeland's visit with one to Mythi Hoang, another stroke victim who lives with her daughter in Lawrenceville, and Enrico DiMatteo, a bed-bound Bloomfield resident who is cared for by his wife, daughter and son-in-law.With each patient and their caregivers, the doctors reviewed medications, conducted blood pressure and other screenings, discussed progress from prior ailments and reviewed home conditions and lifestyle issues that could affect their well-being."This program is great," said DiMatteo's daughter, Philomena. "Any time you call, they do everything. ... We can't bring him to a doctor -- we'd have to be calling an ambulance every time."Such programs are a rarity nationwide both because of a shortage of primary care physicians -- especially geriatricians -- and Medicare reimbursement formulas that fail to meet the true costs of making such visits, said Constance Row, executive director of the American Academy of Home Care Physicians.Medicare might reimburse 10 percent to 20 percent more for house calls, depending on a patient's condition, she said. That could mean compensation of about $20 more for a doctor, which doesn't really cover the time it takes."A doctor in an office sees 20 to 25 patients a day, and the typical doctor making house calls in an urban or suburban setting is making between six and eight," Ms. Row said. "There's just no comparison. It frankly is why doctors who have to maintain office overhead cannot make house calls."Gary Rotstein can be reached at grotstein(at)post-gazette.com. For more stories visit scrippsnews.com