InfoAnda - House calls as cost-saver in health care reform?

Pakistanis angry over detentions in Times Sq. case
Monday, May 24, 2010
ISLAMABAD – Relatives of three men detained by Pakistan for alleged links to the suspect in the attempted Times Square bombing say the men are innocent.
They

Taiwan denies boycotting Australian film festival
Thursday, August 6, 2009

AFP - Thursday, August 6TAIPEI (AFP) - - Taiwan's Beijing-friendly government on Wednesday denied boycotting an Australian film festival amid a row over the e

Merkel's support dips, regional ally resigns International
Thursday, September 3, 2009

By Sarah Marsh and Noah Barkin

BERLIN (Reuters) - Chancellor Angela Merkel suffered a double blow on Thursday as a senior party ally in east German

Minister seeks closure of anti-Berlusconi websites
Wednesday, December 16, 2009
ROME (AFP) - – The Italian government moved Tuesday to close down Internet sites encouraging further violence against Prime Minister Silvio Berlusconi, who

Asian markets mixed after Wall Street rally
Wednesday, March 18, 2009

By ELAINE KURTENBACH,AP Business Writer AP - Wednesday, March 18SHANGHAI - Asia's stock market rally seemed to be running out of steam Wednesday, despite an

S.African farmers look for greener pastures abroad | 12 January 2011
Mosque bomb kills 20, including Afghan governor | 9 October 2010
Iraq to counter lies, show successes via YouTube | Technology | | 26 November 2009

Explosions kill 12, wound 55 in Iraqi city of Kut | 4 August 2010

Forum Views () Forum Replies ()

Read more with google mobile : House calls as cost-saver in health care reform?

Yahoo! My Yahoo! Mail More Yahoo! Services Account Options New User? Sign Up Sign In Help Yahoo! Search web search Home Singapore Asia Pacific World Business Entertainment Sports Technology Africa Europe Latin America Middle East North America House calls as cost-saver in health care reform? By PAULINE ARRILLAGA,AP National Writer - Sunday, November 1 Send IM Story Print RICHMOND, Va. – The doctor doesn't look like much of a crusader, bent over the frail frame of 90-year-old Alberta Scott. He has a lavender stethoscope strung round his neck and some serious bedside manner at work on this stubborn nonagenarian who wants to be anywhere but where she is: in a nursing home bed, hoping to heal and get back home. "Squeeze my hand," Dr. Peter Boling prods. "Squeeze my hand. Come on. Hard!" This is Boling's day job, providing medical care to some of Richmond's oldest and sickest patients. A geriatrician and head of general medicine at Virginia Commonwealth University Medical Center, he visits nursing home patients with a smile, and he leads a team of specialists who take to the road, medical bags in hand, to see patients where and when they need it most _ in their own homes, before a crisis lands them in the ER or a nursing facility. Boling and his team make house calls. And now he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma. There are house-calls programs here and there. San Diego. Boston. The Veterans Health Administration cares for thousands in their own homes, saving money by reducing unnecessary hospitalizations and emergency room visits. But Boling wants to bring house calls to the masses _ up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost-savings, but to provide a financial incentive to persuade more doctors to return to this kind of work. Mostly, it's about people like Alberta Scott and the questions that first came to Boling's mind when he heard she'd been admitted to an institution for treatment of a blood infection. In a few weeks, if all goes well, can she go home? If so, who will take care of her? ___ At 55, Boling has a vague memory of his own pediatrician standing in the kitchen of his childhood home. It's not an image many of us can conjure in an era of overcrowded ERs and specialty clinics. The visiting doc went out not long after the horse and buggy, as technology advanced and institutionalized health care became the norm. In 1930, house calls accounted for 40 percent of doctor-patient encounters. Today, about 4,000 of the nation's 800,000-plus doctors make house calls a substantial part of their practices, the American Academy of Home Care Physicians estimates. Boling was just a young doc himself in 1984 when a mentor persuaded him to spend half his time doing clinic work, and the other half developing a house-calls program. He hung a giant map of Richmond on his office wall and began identifying patients who lived within a 15-mile radius of the downtown VCU medical center. Each home was marked on the map with colored pins, and visits were scheduled by geography to maximize Boling's time. It took only a few stops, and some memorable patients, for Boling to recognize that home care made sense. Take the stroke victim restricted to a second-floor bedroom in his home. Time and again his wife had to call an ambulance, whose crew carried him by stretcher down rickety stairs to an emergency room _ for a bloated gastrointestinal tract, high fevers and vomiting. Turns out, the patient had low blood potassium levels. Boling began drawing blood at the house and prescribed a medication that stabilized his potassium, and staved off ER visits. "It was so stark," says Boling, "the contrast between what he needed and what (the health care system was) giving him." It's that type of patient that Boling envisions being cared for under the proposal pending in Congress. The so-called "Independence at Home" provision is but one small piece of the larger health care reform measures. Where other proposals have divided lawmakers, the house-calls idea is winning support from Republicans and Democrats alike as a "more cost-effective way for these patients to get the coordinated care they need," says Sen. Richard Burr, R-N.C. The provision calls for the Medicare program to partner with home-based primary care teams to test whether house calls would reduce preventable hospitalizations, ER visits and duplicative diagnostic tests for high-cost, chronically ill patients. That means patients with at least two chronic conditions _ congestive heart failure, diabetes, dementia, stroke and so on _ who have been hospitalized in the past year and require assistance for at least two daily living activities, such as bathing, dressing, walking or eating. Patients with multiple chronic conditions account for some two-thirds of Medicare, the almost $500 billion federal health insurance program for seniors. The Department of Veterans Affairs launched its own house-calls program back in the '70s targeting an expanding population of older veterans suffering from multiple chronic conditions. There are now some 20,000 vets enrolled, and a 2002 internal study showed a 24 percent total reduction in their cost of care. Another analysis of one program in Missouri showed costs going from $45,000 per patient per year to $17,000, said Dr. Thomas Edes, who runs the VA program. Medicare officials declined to discuss the house-calls proposal, but Mark McClellan, who ran Medicare under President George W. Bush, called the idea one that "could lead to cost-savings and better outcomes" for patients. "It's definitely worth trying," said McClellan, adding that the strength of the proposal is that practitioners must demonstrate savings in their patients' medical costs in order to get a portion of the savings back from Medicare. That might be easier said than done. Participating practitioners would have to coordinate care in a way that actually reduces all those visits to various doctors and hospitals and, McClellan said, "that's hard to implement in real-world health care." Another challenge is persuading doctors to return to a practice that is unfamiliar to many and looks different in today's world. Technology has certainly made the job easier. Electronic medical records are available via laptop computers. One bulky bag can carry diagnostic tools to test blood, urine and oxygen levels, a blood pressure cuff, an eye chart. Portable, digital X-ray machines and portable EKG machines are also available. Dr. Linda Abbey, a member of Boling's house-calls team for two decades, also carries pepper spray _ though she's never had to use it _ and dog biscuits to keep strays at bay. Cathi Smigelski, a VCU nurse practitioner on the house-calls team, says team members sometimes venture into areas known for drug trafficking. But that hasn't turned her off what she sees as a worthwhile endeavor. "I believe in what we do. ... Peter always says, if all of you docs just did a few, we wouldn't have a phenomenal need. You're going to build a relationship with somebody special. And that person is going to get to a point where they're not going to be able to come see you. Do you say, `Sorry, I don't want to see you anymore'? Or do you say, `Well, let me catch you on my way home'?" ___ Boling's one-man show has grown into a nine-person effort, with three doctors, five nurse practitioners and a social worker caring for about 275 patients with 50 waiting to get into the program. Abbey puts 25,000 miles a year on her Honda Civic visiting one to six folks a day, patients like 83-year-old Edith Taylor, who's lived in the same gray clapboard house for 60 years _ save the 2 1/2 years that she spent in a nursing home following a stroke. "I was determined to come back to my home," Taylor said after a recent checkup. For the past six years, Abbey's been examining Taylor in the middle of a living room decorated with silk flowers and ceramic figurines. "She calls me. She gives me plenty of time to prepare for her. It's a great thing." During the latest visit, Abbey took her blood pressure, listened to her lungs. But there are always important tidbits Abbey picks up just from being in a patient's home. When Abbey ventured into Taylor's kitchen to check her medicine box, she noticed some pills had gone untouched. "You can learn so much about people, not just socially but also medically. You look at what they have. You see the interaction with caregivers. You look at the pills," Abbey says. "It's much easier to develop a medical plan of care if you know all these things." Such was the case with Smigelski and Alberta Scott. Smigelski first saw Scott in her home in late August, after she'd been released from the hospital for treatment of a low heart rate. The spunky 90-year-old told Smigelski that she had plenty of help from her friends at church. It took only a couple of visits for Smigelski to see that while Scott talked a good game, she was worse off than she let on. "She's not eating the way she should. She's not participating in her personal care needs," Smigelski says. Scott quickly deteriorated. She returned to the hospital for a small bowel obstruction and was discharged again only to come down with a urinary tract infection. Back in the hospital, doctors also detected the blood infection that requires two weeks of intravenous antibiotics, resulting in her transfer to the nursing home where Boling saw her. That afternoon, as Boling examined her, Scott seemed small but still had fight. Her niece, Mary Cotton, was visiting from Washington, D.C., and told Boling that Scott desperately wants to remain independent at home. "What do you think is the right thing to do?" Boling asked Cotton, herself 79 years old. "It's hard to make that decision," she said, noting that her aunt couldn't afford to pay someone to stay with her round the clock. So Boling's team is working to get Medicaid to cover a personal care aide. That could take up to 60 days. Should Scott recover from the infection before that, Smigelski has arranged for temporary housing in an assisted living facility. Ultimately, Smigelski and Boling hope that Scott can return home. If she does, she'll become a regular on the house-calls rotation. Boling knows exactly why. "When I started making visits ... and I saw how poorly we were doing taking care of them and how much happier they were when we changed their care from the clinic to their home, I realized that for that group of people, it was just better," Boling says. "It was just better to do." Recommend Send IM Story Print Related Articles Iraqi man suspected in attacks kills officer AP - 2 hours 46 minutes ago Mexican farm group says leader killed AP - Sunday, November 1 Pa. mom, toddler son in stroller killed by train AP - Sunday, November 1 Man rescues phone from dump by listening for ring AP - Sunday, November 1 Girl shot dead after Calif. school football game AP - Sunday, November 1 News Search Top Stories Iran says EU firms in talks to bring its gas to Nabucco US stocks slide ahead of Fed rate decision, jobless data Hamilton seizes pole in Abu Dhabi GP Stimulus plan created one million jobs: US officials Arise, Sir Dracula! Christopher Lee knighted More Top Stories » ADVERTISEMENT Most Popular Most Viewed Most Recommended Arise, Sir Dracula! Christopher Lee knighted Diarrhoea kills 'three times more than thought' Swine flu deaths soar, Ukraine closes schools Hamilton fastest in first Abu Dhabi GP practice Somali centenarian weds 17-year-old More Most Viewed » Mobile phone giant Nokia sues Apple over patents Huge dinosaur find in China 'may include new species' More Most Recommended » Elsewhere on Yahoo! Financial news on Yahoo! Finance Stars and latest movies Best travel destinations More on Yahoo! News Home Singapore Asia Pacific World Business Entertainment Sports Technology Subscribe to our news feeds Top StoriesMy Yahoo!RSS » More news feeds | What are news feeds? Also on Yahoo Answers Groups Mail Messenger Mobile Travel Finance Movies Sports Games » All Yahoo! Services Site Highlights Singapore Full Coverage Most Popular Asia Entertainment Photos Copyright © 2009 Yahoo! Southeast Asia Pte. Ltd. (Co. Reg. No. 199700735D). All Rights Reserved. Terms of Service | Privacy Policy | Community | Intellectual Property Rights Policy | Help

Other News on Sunday, 1 November 2009
Iranian opposition leaders vow defiance
Berlusconi corruption trial on November 27: judicial sources
Iraqi politics shuns sectarianism as violence ebbs
Clinton meets Abbas and Israel to push peace talks | International |
US bid to revive Mideast talks falters over settlements
Bush, Gorbachev, Kohl mark Berlin Wall's fall | International |
Baghdad bombing suspect kills policeman during questioning
Iraqi politics shuns sectarianism as violence ebbs | International |
Six held over UN hostel attack: Afghan intelligence
Egypt party meet won't answer who succeeds Mubarak | International |
S. Sudan president makes first call for independence | International |
Girl shot dead after Calif. school football game
Sources: Abdullah to pull out of Afghan runoff
Australian oil spill 'putting animals at risk'
Officials find gator that escaped at show and tell
Hawaii celebrates new saint, return of relic
Afghan official: 8 linked to UN attack arrested
Bus overturns, injuring 13 college band members
Street battles as 33 militants killed: Pakistan army
House calls as cost-saver in health care reform?
'Two killed, 100 hurt' in Bangladeshi workers riot
Afghan official: We had advance intel on UN attack
Last 2 arrests made in case linked to Detroit imam
India marks 25 years since Indira Gandhi assassination
Standard time back to the standard on Sunday
Myanmar's Suu Kyi supports US policy of engagement
Gunmen ask £1.2 million ransom for priest in Philippines
Kohl, Bush, Gorbachev remember Cold War in Berlin
Cops find up to 6 bodies at home; Ohioan arrested
Father of China's space tech program dies at 98
Shevardnadze: Opposition to tearing down Berlin Wall fierce
Rock 'n' roll royalty jam for 2nd night in NYC
Abdullah to announce Afghan run-off decision
Karzai rival poised to make run-off decision | International |
Berlusconi to stand trial, vows to cling to power
ECB rates on hold, experts view bank loan policy
Clinton urges Abbas to talk without settlement halt | International |
Clinton urges swift resumption of Mideast peace talks
Iceland lifts capital controls as crisis eases
Senior Iran MPs reject U.N. atom fuel plan | International |
Senior Iran reformer freed on bail: report | International |
Iran says EU firms in talks to bring its gas to Nabucco
Clinton: Afghan runoff not affected by Abdullah
US stocks slide ahead of Fed rate decision, jobless data
Somali pirates split on demands for British couple's release
Guyana police accused of burning boy's genitals | International |
Clinton urges Abbas to talk without settlement halt
Hamilton seizes pole in Abu Dhabi GP
Egypt party meet won't answer who succeeds Mubarak
South Sudan president makes first call for independence
Iraqi man suspected in attacks kills officer
Baghdad bombing suspect kills policeman during questioning
No Philly transit union strike during World Series
No trick: 2,000 kids knock on White House door
Obama tempers economic news with caution on jobs
Ariz. jails Iraqi driver after daughter run down
Arrest made in fire at NYC chapel for 9/11 victims
After all the fuss, public health plan covers few
Six Guantanamo Uighurs arrive in Palau: US
Calif. searchers scour seas 2 days after air crash
6 Guantanamo detainees resettle in Palau
Pakistan says soldiers close in on Taliban bases
Northwest plane hits birds, lands safely in Minn.
US military deaths in Afghanistan region at 831
4th typhoon in month lashes Philippines; 7 killed
Abdullah plans runoff boycott to delay Afghan vote
Source: 6 Guantanamo detainees resettle in Palau
Perrett treble proves too much for France
Yuvraj, Dhoni take India to victory
Hope and despair live side by side in Kabul
Bomb kills seven Pakistani soldiers after Clinton warning
US-ENTERTAINMENT Summary
"Glee" cast to get Hollywood diversity award
Glee cast to get Hollywood diversity award | Entertainment |
Malaysia's Maxis to make SEAsia's biggest listing
S.Korea Oct exports underscore global recovery woe
SKorea's October trade surplus 3.79 bln dollars
Sanyo to supply batteries to Peugeot hybrid
Taiwanese face death with 'living funerals'
S.Korea Oct exports per working day hits 1-yr high
India government to import rice: report
Obamas host Halloween event at orange White House
Luxury brands hunt for untapped markets
Sick Elton John postpones US gigs with Joel
US-ENTERTAINMENT Summary
"Glee" cast to get Hollywood diversity award
Amsterdam grapples with integration since filmmaker's murder
Thousands march in Taipei for gay marriage
Moroccan town beats to tune of Judeo-Arab music
Book: White House 'the American house next door'
Abdullah pulls out of Afghan run-off election
Afghan run-off should take place: Karzai spokesman
Senior Iran reformer freed on bail
Pakistan zeroes in on major Taliban bases | International |
Bicycle and bus bombs kill 8 in Iraq | International |
Frustrated in Iraq, U.S. troops eye Afghan action | International |
Saudis find arms cache linked to August arrests: report | International |
Thai police arrest two people in stock rumor probe | International |
Clinton arrives in Morocco on Mideast peace push
Fire on leaking oil rig off Australian coast
Beijing's first snow of season 'artificially induced'
Myanmar torches seized drugs: state media
AP NewsAlert
6 former Guantanamo detainees resettle in Palau
Myanmar burns nearly $20 million of seized drugs
India oil blaze rages on, ten dead: official
Iran ship crew rescued from Yangtze: state media
Oil rig in Timor Sea catches on fire
Philippines cleans up after latest deadly typhoon
Taiwan group vows referendum to block US beef
India sees Pakistani hand in fake note flood
Free trade plan urged for Taiwan, Japan: report
Vietnam starts building big container port: report
Qatari firm in talks to make Prophet Mohammad film | Entertainment |
Australia ups capacity to handle boatpeople
Landscapes, ideas blossom on Berlin Wall death strip
Greece at new risk of being pushed off euro
Bodies of missing Tenn. mom, Jo Ann Bain, and daughter found
Female Breasts Are Bigger Than Ever
AMD Trinity Accelerated Processing Units Now in Volume Production
The Avengers (2012 film), made the second biggest opening- and single-day gross of all-time
AMD to Start Production of piledriver
Ivy Bridge Quad-Core, Four-Thread Desktop CPUs
Islamists Protest Lady Gaga's Concert in Indonesia
Japan Successfully Broadcasts an 8K Signal Over the Air
ECB boosts loans to 1 trillion Euro to stop credit crunch
Egypt : Mohammed Morsi won with 52 percent
What do you call 100,000 Frenchmen with their hands up
AMD Launches AMD Embedded R-Series APU Platform
Fed Should not Ignore Emerging Market Crisis
Fed casts shadow over India, emerging markets
Why are Chinese tourists so rude? A few insights

USD EUR - 1 year graph	VPN on MacOSX	BlogMeter 1.01