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Housecalls: A Viable Option to Reach Patients

Housecalls: A Viable Option to Reach Patients. Long Term Care Integration Project Aging & Independence Services San Diego County. James F. Brinkman, MD. Presentation. Who, what, why, where, and how… Case Study Challenges Invitation. What I Am Not…. A Pioneer An M.B.A.

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Housecalls: A Viable Option to Reach Patients

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  1. Housecalls: A Viable Option to Reach Patients Long Term Care Integration Project Aging & Independence Services San Diego County James F. Brinkman, MD Housecalls: A Viable Option to Reach Patients

  2. Presentation • Who, what, why, where, and how… • Case Study • Challenges • Invitation Housecalls: A Viable Option to Reach Patients

  3. What I Am Not… • A Pioneer • An M.B.A. • A Financial Wizard • An Expert? Housecalls: A Viable Option to Reach Patients

  4. Who I Am… • Family Physician • M.C.O./The Toledo Hospital • US Navy • A-Z • Member, American Academy of Home Care Physicians Housecalls: A Viable Option to Reach Patients

  5. Why I’m Here… • Medicine’s Trends • Medical Economics 11/5/04 Issue • Less Money • More Regulation • Less Control… Catch 22 Housecalls: A Viable Option to Reach Patients

  6. Why… • Burnout &/or Insight? Housecalls: A Viable Option to Reach Patients

  7. Why… • Less Patient-Centric • Physician’s Offices • Hospitals • Managed Care • The Aging of America • Access to Care = 911 Housecalls: A Viable Option to Reach Patients

  8. Where… • Patient’s Homes • From RSF to shacks • Assisted Living • From where they beg to go… to where they beg to leave • SNF’s • A different world Housecalls: A Viable Option to Reach Patients

  9. Where Not… • Hospitals? • The Very Rural? • Unsafe Neighborhoods? • A Replacement for 911? • NOT!!! Housecalls: A Viable Option to Reach Patients

  10. How… • The Black Bag • POS Technology • The ‘Office’ Housecalls: A Viable Option to Reach Patients

  11. The Black Bag • Standard Diagnostic Equipment • Pulse Oximeter • Injectables • NTG • TransDerm Scopalamine • Trays/Dressings/Suture Material • Foley Catheters/FemCaths Housecalls: A Viable Option to Reach Patients

  12. The Black Bag (Cont.) • Venipuncture (Arterial) Supplies • Syringes/Needles • Hemoccults • Saline • Betadine/Lidocaine/K-Y/Bacitracin • Ear Lavage Housecalls: A Viable Option to Reach Patients

  13. The Black Bag (Cont.) • Anoscopy/Headlamp • Sharps Container • Gloves: Sterile & Non-Sterile • Batteries • Nail Nippers • Trauma Scissors Housecalls: A Viable Option to Reach Patients

  14. The Black Bag (Cont.) • Cell Phone • Camera • Digital preferred • Organizer/PDA • Small References • Treo 600 SmartPhone Housecalls: A Viable Option to Reach Patients

  15. The Black Bag (Cont.) • Charts • Forms • EMR…. Housecalls: A Viable Option to Reach Patients

  16. POS Technology • Multistix 10 SG • Histofreezer Housecalls: A Viable Option to Reach Patients

  17. POS Technology • ECG (midmarkdiagnostics.com) • Holter (midmarkdiagnostics.com) • PFT (midmarkdiagnostics.com) • ICG (bioz.com) • iSTAT PCA (iSTAT.com) Housecalls: A Viable Option to Reach Patients

  18. POS Technology • Biosite (www.biosite.com) Housecalls: A Viable Option to Reach Patients

  19. The ‘Office’ • Computer/Laser Printer • Fax • Scanner • Phone • Shredder • Centrifuge (LabCorp) Housecalls: A Viable Option to Reach Patients

  20. The ‘Office’ • Supplies • Coding • Billing • Virtual Receptionist • AccessLine.com Housecalls: A Viable Option to Reach Patients

  21. Who Needs Housecalls? • Anyone! • Homebound • Frail Elderly • Acutely ill • Disabled • Bedbound Housecalls: A Viable Option to Reach Patients

  22. Who Needs Housecalls? • Recently Discharged from Hospital or SNF, and unable to get in to see their physician • Prevent ‘Bounce-backs’ Housecalls: A Viable Option to Reach Patients

  23. My Model • Solo • No ‘Tech’ • Professional Corp. (S Corp) • Collaborate with PCP’s • Collaborate with Hospitalists/Specialists • Soon to add Mid-Level Providers • PA’s • NP’s Housecalls: A Viable Option to Reach Patients

  24. Team/Resources • Medicare-Covered • ***IF APPROVED*** • NOT Medicare-Covered Housecalls: A Viable Option to Reach Patients

  25. Team: MC-Covered • Home Health/Hospice Agencies • RN/LVN • PT/OT/ST • CHHA • MSW • Dietitian • Chaplains/Volunteers Housecalls: A Viable Option to Reach Patients

  26. Team: MC-Covered • Oxygen/Respiratory Support DME • Pacific Pulm. Svcs. • Nocturnal Oximetry • Oxygen • Nebulizers • Progressive Medical • Cough Assist • Ventilators • TXP Housecalls: A Viable Option to Reach Patients

  27. Team: MC-Covered • Radiology • Mobile • BioPath • Non-Mobile • Ultrasound (CVT) • Echo • Abdominal • Extremity, (A&V) Housecalls: A Viable Option to Reach Patients

  28. Team: MC-Covered • Pharmacy • Delivery vs. Pick-up vs. Mail-Order • Compounding • IV: Option Care • Resp: MedMart Housecalls: A Viable Option to Reach Patients

  29. Team: MC-Covered • DME • Beds, including home Clinitron® • Air-Mattress Overlays • Commodes • Walkers/Canes • Scooters • Trapezes Housecalls: A Viable Option to Reach Patients

  30. Team: MC-Covered • DME • Suction • IV Pumps • Nutrition Pumps Housecalls: A Viable Option to Reach Patients

  31. Team: MC-Covered • Ambulance • AMR • Balboa Housecalls: A Viable Option to Reach Patients

  32. Team: NON-MC-Covered • Patient • CG’s/Spouses/Family • Case/Care Managers • Elder Care Attorneys • Fiduciaries/Conservators • DPOAHC’s Housecalls: A Viable Option to Reach Patients

  33. Team: NON-MC-Covered • Community-Based Organizations • APS/Senior Team • IHHS • Meals-On-Wheels • Police/Fire/Rescue Personnel • Lifeline®/SafeReturn® • Medical Alert Bracelets • Companion Canines Housecalls: A Viable Option to Reach Patients

  34. Team: NON-MC-Covered • Marcia • The Great Physician Housecalls: A Viable Option to Reach Patients

  35. Case Studies • W.B. • 80 yo WF • Bedbound since 1991 s/p Laminectomy, post-op Cord Hematoma caused paraplegia • 1 mo. Later: Hemorrhagic CVA, had craniotomy; resulting L. Spastic Hemiplegia Housecalls: A Viable Option to Reach Patients

  36. Case Studies • W.B. • HTN • Dementia • Cardiomyopathy • Chronic Pain • DJD • Spasms • RSD • Neurogenic Bladder Housecalls: A Viable Option to Reach Patients

  37. Case Studies • W.B. • Chronic Tinea Pedis • Cellulitis • Hx. Urosepsis • Hx. Decubiti • Chronic Constipation • Requires digital extraction q 3-4d Housecalls: A Viable Option to Reach Patients

  38. Case Studies • W.B. • Lives in SFD • 24/7 CG • HH • Foley • Air-Mattress Overlay Housecalls: A Viable Option to Reach Patients

  39. Case Studies • W.B. • Avoided ED Visits & Hospitalizations for… • Urosepsis • CHF • Impactions • Clogged Foleys Housecalls: A Viable Option to Reach Patients

  40. My Role… • PCP = Quarterback • Call & Run the plays • Rely on my Front Line • Sometimes I Pass or Handoff the Ball • Sometimes I Run the Ball • Most of the time… We Score! • Rarely, We Punt. Housecalls: A Viable Option to Reach Patients

  41. Role of The Physician/Provider • Member of Interdisciplinary Team, not above it • Assess, Treat, Prescribe, Certify and Monitor Home Visits and Care • Care Plan Development and Oversight • Evaluate Quality of Care Housecalls: A Viable Option to Reach Patients

  42. Role of The Physician/Provider • Communicate and Coordinate • With Patient • With Family • With Care Manager and the Multitude of other Team Players Housecalls: A Viable Option to Reach Patients

  43. My Goals… • As long as it’s feasible and appropriate… • To keep patients at home • To keep patients out of the ED & hospital • To keep patients as independent as possible • To keep the family together • To rally as many resources as I can to help accomplish that • To provide compassionate, thorough, dignified care Housecalls: A Viable Option to Reach Patients

  44. My Goals… • Recognize that sometimes it’s… • Not Feasible • Not Appropriate Housecalls: A Viable Option to Reach Patients

  45. Benefits Of Medical Housecalls • Improved Access to Care • Prevent Unnecessary Hospitalizations • Prevent Unnecessary ED Visits • Improved Health Outcomes • Improved Quality of Life Housecalls: A Viable Option to Reach Patients

  46. Benefits Of Medical Housecalls • High Patient Satisfaction • Regardless of age, surveys indicate Pts. prefer to be cared for in the home • More comfortable in their own home • More likely to be compliant Housecalls: A Viable Option to Reach Patients

  47. Benefits Of Medical Housecalls • High Family Satisfaction • Reduced Stress! • Improved Logisitics • Less time lost from work/job Housecalls: A Viable Option to Reach Patients

  48. Benefits Of Medical Housecalls • Cost-effective vs. repeated ED Visits and Hospitalizations • Technology allows far more POS diagnosis and procedures than previously available Housecalls: A Viable Option to Reach Patients

  49. Challenges & Barriers • Managed Care • Medicare • Medi-Cal • 3rd Party Payors Housecalls: A Viable Option to Reach Patients

  50. Challenges & Barriers • Malpractice • Declining Reimbursements • Increasing Expenditures • Increasing Federal, State, and Local Regulation Housecalls: A Viable Option to Reach Patients

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