| Hospital emergency departments (EDs) were | | | | some have decided if you can't fix the problem |
| initially designed to provide immediate care for | | | | you may as well feature the problem. |
| patients experiencing acute medical conditions and | | | | The modern day medical house call can now offer |
| serious trauma victims. Once patients were | | | | many of the same services that were once only |
| stabilized they were either discharged home or | | | | available in the emergency room. In the modern |
| transferred to another location for more | | | | day medical house call patients can have |
| advanced and specialized care. Now, EDs are | | | | comprehensive physical exams that include blood |
| experiencing increased use by people who do not | | | | work, EKGs, x-rays, and ultrasounds (cardiac |
| have a primary care provider and use the ED for | | | | echo, carotid Doppler studies etc). These tests |
| routine medical care. The increased inappropriate | | | | are often sufficient to provide the needed data to |
| usage of the ED places an increased stress on | | | | make a diagnosis and establish a treatment plan. |
| already strained healthcare resources. | | | | Another benefit of the medical house call is the |
| EDs have responded to the increased usage for | | | | clinicians that are seeing you are able to give you |
| non-emergent services by offering many more | | | | their undivided attention. Also you will be able to |
| resources than the original emergency room. Now | | | | see the same health care provider as opposed to |
| the ED has more diagnostic and treatment | | | | the doctor of the day or medical resident. |
| options than were previously intended. The ED | | | | Another advantage of the medical house call is |
| now is a self-sufficient unit within the larger | | | | the increased privacy that you are afforded by |
| medical center, and has become integrated into | | | | the nature of staying in your home. If patient use |
| the patients' continuum of care. In-house specialty | | | | the medical house call for their primary care |
| consultations are usually immediately available as | | | | needs as well as their sick day needs they may |
| are advanced diagnostic studies. This has perhaps | | | | be able to spare themselves the stress and risks |
| led to a perpetuation of the misuse of the | | | | of a trip to the emergency room. |
| modern day emergency department. | | | | Some common conditions that can be treated in |
| An increasing problem is the misuse of | | | | the home include common pulmonary infections |
| emergency services by patients who do not have | | | | (pneumonia & bronchitis), gastrointestinal |
| a primary care provider and use the ED for | | | | conditions (stomach flu & abdominal pain), |
| routine and non-urgent care. Less than 10% of | | | | dermatological conditions (2nd degree burns, acne, |
| emergency room visits are actually emergencies. | | | | rashes), chronic conditions (diabetes, COPD, |
| More than half of the patients that present to the | | | | hypothyroid, obesity, congestive heart failure, high |
| ED could be better served by being treated in | | | | blood pressure), urological problems (urinary tract |
| place (home, skilled nursing facility, occupational | | | | infections, prostate inflammation, kidney stones), |
| health office, or added on to a PCP schedule). | | | | and dehydration. One preventative care measure |
| One-third of ED visits could be treated in a | | | | that can be done in the home that is not typically |
| Primary Care Provider office. It has been well | | | | done in an ER or even a traditional doctor's office |
| established treatment in Emergency Departments | | | | is health behavior counseling for lifestyle |
| is more expensive than in any of the above | | | | modifications. Typically this is done in doctor's |
| mentioned potential care settings. | | | | offices and Emergency rooms by giving you a |
| Despite the high cost of ED services | | | | generic handout. The reason for this is because |
| non-emergent use of emergency services | | | | the traditional care environment is focused doing |
| continues to grow. Many non-urgent ED visits | | | | the least amount of care possible to meet the |
| could have been avoided if patients had a | | | | needs of the masses that are waiting to be seen. |
| pre-existing relationship with an accessible primary | | | | Emergency rooms were initially designed to treat |
| care provider. In addition to the financial cost, | | | | acute medical conditions and to stabilize trauma |
| crowded waiting areas, long wait times, actual and | | | | patients before they are transfer to the |
| potential delays in receiving medical care patients | | | | appropriate treatment location. Unfortunately, EDs |
| are subjected to increased risk for medical errors, | | | | have also become a place to seek treatment for |
| exacerbation of pre-existing conditions, and | | | | many people who do not have a primary care |
| nosocomial infections. ERs will be swamped in the | | | | provider. As a result, the numbers of emergency |
| middle of the flu season with a combination of | | | | visits has increased, although the reasons for the |
| patient types some with actual flu or swine flu | | | | visits are often not emergencies. Non-emergent |
| while others have minor sprains. Now the person | | | | visits are causing a huge backlog of real |
| with the sprain has been exposed to the highly | | | | emergency patients and increasing the amount of |
| contagious flu. | | | | money spent on healthcare. |
| The medical house call has started to make | | | | A new medical house calls company in NYC has |
| resurgence in many parts of the country to help | | | | recently opened which allows patients to |
| address many of the primary preventative | | | | communicate with their PCP online via a secure |
| non-urgent care needs of patients. The average | | | | patient portal. Patients can request appointments |
| ED visit in NYC can cost upwards of $800 and | | | | online. The Nurse Practitioner arrives at the |
| brings with it the risks of medical errors due to | | | | patient's home, office or hotel usually the same or |
| many different health care providers, loss of | | | | next day. The NP can diagnose the problem, |
| work and wages due to prolonged wait times, and | | | | order tests (most of which can be done at the |
| infectious disease risk due to the gathering of | | | | patients home) and electronically submit a |
| people with airborne illness (Influenza, H1N1, staph | | | | prescription to the local pharmacy that can |
| and strep infections). | | | | typically deliver the medication. The company also |
| The average cost of a medical house call in NYC | | | | offers established patients the convenience of |
| ranges from $150- $600 and greatly reduces the | | | | web-cam follow-up appointments and email |
| risk of nosocomial infections, saves time and | | | | consultations, which allows patients to take their |
| reduces lost wages because the patient is able to | | | | primary care provider with them when they |
| wait in the comfort of their own home. Often | | | | travel. All of this costs a fraction of what the |
| times being able to see the patients normal | | | | starting price of an ER visit would be. Patients can |
| environment can provide many clues for | | | | use their flex spending and health savings |
| diagnosing a condition at a fraction of the cost of | | | | accounts or major credit card to pay for this |
| the ER visit. One hospital in Connecticut has even | | | | service. As the debate over health care continues |
| gone to posting wait times on line for their ERs so | | | | more and more innovative and market solutions |
| patients can log on and see how long it will take | | | | will answer the call to solve the nations health |
| to be seen. As much as policymakers say they | | | | crisis. The problem will be if policy is made to stifle |
| would like to reign in cost of health care clearly | | | | innovation. |