House Call Physicians working to bring cost containment home

LONGMONT — Remember when it was common practice for doctors to make house calls?

House Call Physicians in Longmont is helping the practice make a comeback.

Doctors have seen 1,800 people up and down the Front Range in the past 3 1/2 years, according to Brian Mathwich, founder of the practice. House Call Physicians PC focuses on seniors and disabled patients who live at home.

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Because of House Call Physicians and his caregiver, a 90-year-old patient with a surgical wound that has not healed in a year and a half is looking forward to his annual five-month trip to Arizona rather than a stay in the hospital, said Rohini Kanniganti, his doctor.

The patient is not able to drive because he has macular degeneration, meaning he can’t see well, Kanniganti said. The patient’s surgical wound remains, after he had a kidney removed a year and a half ago when doctors found he had kidney cancer.

But his female partner is taking care of the wound and it’s not getting worse, Kanniganti said. The man’s name and his partner’s name were not released for privacy reasons.

“We look after very sick people who are maybe in the last five years of their lives,” Kanniganti said. “I feel deeply honored to work with them. It teaches me about what it means to become old.”

The patient also has high blood pressure and anemia, Kanniganti said. She checks the man’s laboratory results frequently to make sure he is as healthy as he can be, given all of his health problems. For example, if his sodium levels are too low, it would be easier for the patient to get dizzy and fall in his house, Kanniganti said.

“He is not able to drive or go out on his own,” Kanniganti said, “but he otherwise reports that he has been doing very well.”

The patient is just one of hundreds that Kanniganti and other doctors at the practice see on a regular basis. House Call Physicians appears to be the only practice of its kind in northern Colorado, Mathwich said. Based in Longmont, it serves patients from Fort Collins to Littleton.

While the privately held business does not release revenue numbers, it generally relies on fee-per-visit payments from Medicare, said Richard Gianzero, the company’s business development manager. In general, Medicare reimburses doctors about 30 percent less than do private insurance companies.

A new, federal Independence at Home trial program may increase competition for such patients and programs, Mathwich said. The three-year trial program focuses on health care for patients in their homes, he said.

The trial program is part of the Patient Protection and Affordable Care Act passed by Congress in 2010. It has a goal of reducing Medicare costs for health care for seniors.

While House Call Physicians is not participating in Independence at Home, Mathwich predicts it would continue whether a Republican or Democrat was elected to the White House.

“We’re going to save money and keep people out of the hospital and the emergency room,” Mathwich said.

House Call Physicians also offers other health services.

Mathwich contracts with a behavioral health team, an ophthalmologist, a podiatrist and other service providers. The business can offer X-rays, nursing and physical therapists, outsourced from another company.
“We’re offering more services to our home patients because they can’t get out to get those services, and then they end up needing them in the emergency room after an ambulance ride,” Mathwich said. “We’re trying to become a solutions provider.”

When doctors visit patients in their homes, they’re able to check potential misuse of medications much more easily, Gianzero said. They’re also able to meet with family members more readily, Kanniganti said.

Checking for potential fall risks also is an important part of seeing a patient at home, Gianzero said. Nationally, 2.2 million patient falls were reported to Medicare in 2011, with more than 20,000 injury-related deaths, he said.

“In this fashion, with the high-risk population, you can help avoid predictable emergencies,” Gianzero said. “And from a financial perspective, Medicare sees that this type of practice does save the system money.”

Gianzero did not have statistics to back up the money-saving claim.

But patients also see numerous informal benefits not captured by statistical costs, Kanniganti said. Such home doctor visits can be a major factor in deciding whether a patient can stay at home or must move to an assisted-living facility or nursing home, for example, she said. Such facilities can cost individuals and government programs more money.

“It’s really wonderful for them to be in their homes — to be familiar with a place they can function in,” Kanniganti said.

Senior patients who are able to stay in their homes are less likely to deal with depression and the feeling of a loss of independence from moving to a care facility. Kanniganti said that also can save money.