A San Diego Physician Brings the Modern Day Housecall Back Home.
Gresham Bayne, MD, Board Certified in Emergency Medicine, is the founder of the Call Doctor Medical Group in San Diego, California, a medical group that has harnessed the power of the latest medical diagnostic and communications technologies in order to practice medicine the way doctors did 50 years ago… by visiting patients in their homes… by bringing back the physician who makes housecalls.
Dr. Bayne built his first mobile medical van in the early 1980s and began making housecalls in order to clinically prove the concept. Over the next two years he made 250 housecalls, as he re-engineered his medical van to house the items that had proven themselves crucial to his mobile healthcare mission.
He established The Call Doctor Medical Group in 1985. The idea was simple: Prompt, comprehensive medical care delivered in the home is more desirable and less expensive than hospital-based options.
When getting out to receive medical care was difficult or even impossible, The Call Doctor Medical Group, Inc. would put a doctor on your doorstep – when necessary within 60 minutes and without the need for advance appointments. Dr. Bayne’s medical group of physicians making housecalls became known for being able to deliver qualified, caring, board-certified physicians and nurse practitioners who were equipped to provide expert in-home diagnosis and treatment at a fraction of the cost of an emergency room visit.
Prior to founding The Call Doctor Medical Group, Dr. Bayne served as Chief of the Department of Emergency Medicine at the Naval Regional Medical Center in San Diego, he was Associate Professor of Medicine at the University of California, San Diego Medical School, and Associate Director of Life Flight at UCSD Medical Center. He is a Fellow of the American Academy of Emergency Physicians and is a Director and Treasurer for the American Academy of Home Care Physicians.
Dr. Bayne was honored as “Housecall Doctor of the Year” by the American Academy of Home Care Physicians (AAHCP), but he considers his highest honor being voted “The doctor who cares the most about his patients” during his internship in 1973.
In 1987, Call Doctor Medical Group, Inc. became a multi-specialty family practice with a group of senior staff physicians from Scripps Memorial Hospital in La Jolla, California. Today, the Call Doctor group is the leading supplier of comprehensive medical care delivered in the home in San Diego, Riverside and San Bernardino counties, having served a wide variety of patient populations, on 60,000 housecalls to date… and counting.
The group’s mission is to become America’s leader in providing management and support services to physicians and medical plans seeking to enhance service and quality of care in the home environment. In the years to come, Dr. Bayne intends to roll his concept for in-house medical care across America.
Call Doctor is like a well-equipped, professionally staffed emergency room that comes to the patient’s home. It’s a medical group founded on Dr. Bayne’s strong belief that there is no better place to receive medical treatment than in the comfort and healing environment of one’s own home.
Cost Containment Without Compromising Care…
Obviously, controlling the costs associated with health care delivery has emerged as a priority concern and compelling force for the overhaul of America’s healthcare system. And Dr. Bayne has worked tirelessly for decades to prove that Call Doctor is the ideal solution to daunting problems like the over-utilization of ambulances and high emergency room costs.
Further, Dr. Bayne explains that it is widely recognized that emergency rooms are the most inefficient and costly places to receive primary care. Approximately 80-85% of the 100 million ER visits each year are not necessary to save life or limb. When a patient does reach the emergency room, studies have shown that they receive tests and procedures that could have easily been accomplished by Call Doctor physicians in the home… and at a fraction of the cost.
Today, the Call Doctor services are covered by Medicare, private insurance, and Workers Compensation insurance. And the Health Care Finance Administration (HCFA) has approved a doubling of maximum reimbursement for urgent housecalls.
With powerful portable technology, the physician is the emergency room
Technology has made it possible to essentially bring the hospital home. The revolution in micro-electronics that gave us the tiny smart phones we use today also delivered a new generation of hand-held diagnostic equipment, often so compact that it can be carried in a physician’s pockets. And it’s equipment that can detect life-threatening conditions with the same certainty as hospital emergency rooms and laboratories.
Imagine a fully functional EKG machine no bigger than a box of chocolates and a pulse oximeter the size of a walnut.
Physicians are dispatched to patients’ homes, equipped with every diagnostic tool necessary to assess a patient’s symptoms, along with a full supply of standard emergency-care drugs to treat them. If the patient requires X-rays, a Certified Radiation Technologist, will be dispatched to take and develop the X-ray film, and using portable lab and EKG instruments, the physician can make any emergency decision and treatment available at the time of the housecall.
The Call Doc physicians even have access to a fully integrated customized software program that allows the central access to and remote charting of past medical records.
As a result, Call Doctor physicians can effectively diagnose and treat most medical problems in the comfort of the patient’s home. They can set broken bones or provide care for chronic conditions, from flu symptoms to food poisoning. Simply put, Dr. Bayne’s Call Doctor physicians improve the quality of life of for patients, while reducing overall costs for the healthcare industry.
The Call Doctor of today is a team of supporting physicians and nurse practitioners, Home Health Agencies, Discharge Planners and Caregivers all focused on the patient needs. And the group’s board-certified physicians appreciate and welcome the opportunity to be close to their patients and to have a more hands-on role in testing and outcomes.
Elderly patients comprise over half of the Call Doctor patient base. The average age of the group’s older patients is 82, and in intense need of medical services, nearly all of which can now be provided at home.
Dr. Bayne explains that if just 1% of the annual hundred million emergency room visits were converted to housecalls, his medical group’s revenues would exceed $200,000,000 a year while at the same time saving our society some two billion dollars.
Structured for success
The Call Doctor Company is an acute care alternative to the emergency room, with unique advantages in cost effectiveness, convenience, high technology, and close physician/patient relationships. Because of these capabilities and our unrivaled experience, Call Doc is the clear leader in delivering medical care in the home.
In fact, Call Doctor is unique in the United States as the only comprehensive housecall service utilizing board-certified physicians, telephone triage, dispatch and mobile X-ray support.
While the concept of providing physician housecalls might seem simple, the operation and logistics are extremely complex. There is no organization in the U.S. that has more experience with such complexities than Call Doctor, and it would seem that the idea is one whose time has finally come.
CS: Are housecalls really a win for everyone?
Dr. Bayne: Housecalls are a triple win: for patients too sick to go to the doctor, for doctors rediscovering their joy in the autonomous practice of medicine, and the taxpayer paying an average $150 to keep patients away from expensive ERs and hospitalizations… and that includes needed lab and x-rays in your bedroom!
CS: But, how can it be less expensive to have a board certified physician visit one patients home at a time? It sounds like it would be expensive.
Dr. Bayne: It’s simple… armed with the portable technologies of today, doctors can deliver the lab, x-ray and therapies that since WWII have traditionally be delivered in hospitals. Since 75% of healthcare costs are in labor, having a solo doctor drive, locate, interview, exam, test, and treat a patient too sick to walk saves 50-80% of total costs for that patient…and that’s now been proven in numerous studies.
CS: Then why don’t we hear about housecalls more often?
Dr. Bayne: I don’t know exactly why housecalls are still the exception and not the norm, especially since Medicare paid for over four million housecalls last year.
CS: What about HMOs? Won’t they balk at the idea of making housecalls available because it will increase utilization of medical services?
Dr. Bayne: They shouldn’t, but I’m afraid when presented with the idea, they often do. When the CEO of the largest HMO in Texas at the time did some internal research on the applicability of housecalls, he found two reasons not to implement the program.
First, he said that HMO doctors would love having housecalls available as a patient-friendly solution for urgent referrals sitting between their current options: an expensive ER visit versus a low-cost clinic appointment six weeks out. But he also said that the management team felt their high/low cost dichotomy worked well for them by forcing patients to choose the ER on their own and at risk for having to pay for it.
Secondly, he also said that the patients would love receiving housecalls, and therefore there would be no way to control the possible expansion in demand for such services. Those are pretty poor reasons not to implement a housecall program, if you ask me.
CS: Are there housecall programs that are working just fine and showing the all around win you describe?
Dr. Bayne: Sure… there’s long-standing data from 30,000 veterans who for years have received the predominant portion of their care in the home…which consistently shows a reduction in hospital days of two-thirds and in nursing home days of over 80%. Why is this not the focus of public policy debate?
CS: It sounds like a lot of turf protecting… resistance to changing the status quo.
Dr. Bayne: It is hard for me to understand how easily we discarded and continue to ignore a 3,000 year-old, concept so fundamental in its origin. The housecall disappeared overnight with the passage of the Medicare Act in 1963, when doctors suddenly deemed housecalls inappropriate without the diagnostics of the equipment-laden hospital… also realizing how profitable it suddenly became lining up healthy patients up in their office waiting rooms.
CS: And the treatment tools, if you will… they’re really just as good as what is found in a hospital?
Dr. Bayne: We now have better testing equipment in our pockets producing faster results than I could get for the same tests in 1982 running the largest emergency room in San Diego.
CS: Wow. What about 911? Does anyone worry seniors won’t call 911 and be potentially harmed as a result?
Dr. Bayne: First of all, when a patient or caregiver calls our triage switchboard, if we perceive that sort of emergency, we call 911 for them, and secondly, when did our health policies get delegated to high-paid executive physicians who cannot possibly have kept up with the benefits in modern delivery systems? When my 92 year-old Mother falls, why should I call a fireman through the 911 system? When my house is on fire, do I call the doctor?
Is it really worth $27,000 to call a minor laceration over the eyebrow a “code trauma” as I have seen reviewing charts for an insurance company?
CS: But hasn’t managed care helped to reduce health care costs?
Dr. Bayne: No. The great experiment known as “managed care” (or “mangled care” by some) drove costs up so much that the federal subsidy for HMOs reached over 12% compared to traditional Medicare before the current Administration refused to pay it. Of course, by taking 24 cents of every dollar out of direct clinical care, as opposed to 6% for Medicare, HMOs have taught us there is much fat in the system, but it shifted control of your healthcare from physicians regulated through the integrity of the doctor-patient relationship to a group of detached bureaucrats and for-profit boards regulated through the unforgiving process of a stockholder 10-Q.
CS: I didn’t know that.
Dr. Bayne: I don’t know why the public cannot see this. I don’t know why it isn’t obvious to everyone that it makes no sense to pay an HMO doctor for an ill-defined group of future services mostly available now through the internet or public health sites. Managed care is great for wellness programs and those too busy, or lazy, to learn about flu shots and blood pressure control.
CS: So, you really love practicing medicine in the home…
Dr. Bayne: I don’t know why every doctor in this wonderful land doesn’t simply quit and buy a few pieces of equipment and go on the road with us. Leave the bureaucrats behind and provide professional services to those in the Greatest Generation who really deserve it, really need it, and cannot be more appreciative when they offer you the inevitable tea and biscuits as you take a walk thorough history sitting in their living room… which now often looks like an ICU.
And I don’t know why our medical schools have so little devotion to training in the many aspects of mobile medicine. Years ago, the daughter of an orthopedic surgeon about to finish medical school asked to join me for an afternoon of housecalls. Letting her out of my car at the end of the day I asked her for a summary impression, since she had been quite reflective during the housecalls. She waited thoughtfully for long while, then suddenly exclaimed: “My God, I can’t believe I just spent four years learning how to practice medicine the wrong way!”
CS: If the public knew more about what you’re doing, perhaps there’d be more of an outcry.
Dr. Bayne: Medicare pays for millions of housecalls every year, so millions do know. And I don’t understand why the American public simply doesn’t demand a change to housecall medicine as the primary modality for hospice, home health, palliative, and ALL forms of urgent care for All age groups. If you are too sick or unsafe to drive yourself, the application of $150 housecalls to the large deductibles soon to be common with Obamacare should not be blocked by multi-billion industries seeking to preserve the status quo.
CS: So, I wasn’t going to bring it up, but since you mentioned Obamacare, weren’t you involved in some way with a part of it?
Dr. Bayne: Well, a very small part. I co-authored the part of Obamacare that can save Medicare billions… it’s called the “Independence at Home Act.” The simple fact is that a few of us have become convinced that a return to the original Hippocratic Oath is the solution: “….and into whomsoever’s house I may enter, may I see the man, just the man.”
At Complete Senior we salute what Dr. Gresham Bayne has done and continues to fight for, and we recognize that if only more of today’s physicians were even a little more like him, we could solve the problems we face in health care for the benefit of all.