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Onsite Medical Care in the Time of Covid

January 8, 2021

Published in All About Seniors - Charlotte Winter/Spring 2021 Edition

By Alan Kronhaus, M.D., Doctors Making Housecalls

Ms. Ann Marie Smith, 87 years old and grandmother of 6, slipped and fell on her way to the
bathroom in the wee hours of the morning. Her community caregivers responded promptly and helped her get back in bed. They wanted to send her to the ER for x-rays, to make sure nothing was broken. Despite being in pain, however, Ms. Smith refused to go. She didn’t want to expose herself to lots of sick people! Concerned, her caregivers appealed to her daughter-in-law, but she was even more adamant about not putting mom into harm’s way. What to do?
Of all the things scientists have learned about Covid-19 since the start of the pandemic, one of the most important is that the virus preferentially attacks senior citizens, often with devastating effects. If a person suffers from a chronic medical condition such as diabetes, heart disease or even obesity, or lives in a communal setting, that person is even more vulnerable to contracting the disease and if they do, to suffering significant consequences. That’s the bad news.
The good news is that nowadays it is possible to get the medical care you need AND avoid exposing yourself to other sick people, whether in a doctor’s office, urgent care clinic or emergency room.

Nowadays, you can have a doctor come to you! There are several medical practices that are reviving the old-fashioned house calls with a 21st century level of sophistication. They specialize in providing comprehensive primary care services in the comfort, convenience, and SAFETY of their patient’s own environment.
Primary care services are defined as non-emergency services that
• are provided upon the patient’s initial contact with the profession – at the interface between the patient
with the profession, as opposed to services that require a referral from another physician;
• focus on the care of the whole person, as opposed to one or another organ system (for example, cardiology, neurology, dermatology, etc.); and
• those which extent longitudinally over time. Typically, these medical practices can do everything in their patient’s home that most primary care doctors do in an office or clinic, including lab work and medical imaging, to determine if patients like Ms. Smith broke a bone. They can refill prescriptions, adjust medications, and prescribe new medicine which
might be required. They can also arrange for home health agency services which Medicare will pay for if the patient is homebound. Those services including physical therapy, occupational therapy, wound care, and skilled nursing services.

The services provided by these specialized practices often include same or next day urgent care
services; however, none of the practices provide emergency medical services. If a patient believes a problem is a true medical emergency, they have no choice but to call 911 straightaway.
Happily, most of these practices are “in network” with nearly all insurance plans including Medicare. That means they bill patients only for amounts that are “patient responsibility” according to their insurance plan. As such, the patient would pay the same for the care provided in their home would be the same as the cost for the same services provided in a doctor’s office or urgent care clinic. Some home visit practices charge a modest “trip fee” to compensate their clinicians for the opportunity cost of travel time. The practices which charge a trip fee for care provided in a private residence waive that free when they see a patient in one of the 700 or so “senior living communities” these practices visit on a regular basis, often twice weekly. Such communities include independent and assisted living facilities (ILFs and ALFs), as well as continuing care retirement communities (CCRCs).

As part of its commitment to providing comprehensive, whole-person, primary care services, home visit practices may also provide mental/behavioral health services, including various modalities of “talk therapy” as well as medication management. Increasingly, some of the practices also provides medical subspecialty services of particular importance to seniors, including podiatry, orthopedics, cardiology, neurology, nephrology and urology.

Onsite Medical Care In the Time of Covid is written by:

Alan Kronhaus, MD received his BA and MD degrees from Boston University. He did an internal medicine residency at the University of Utah Medical Center, and fellowship training as a Robert Wood Johnson Clinical Scholar at UNC-Chapel Hill, where he then served on the faculty for over a decade. In 2002 he founded Doctors Making Housecalls with his wife, Shohreh Taavoni, M.D. Dr. Kronhaus currently serves as the practice’s CEO and Dr. Taavoni as its President and Chief Medical Officer.

All About Seniors
William Sweezy