You can use your wireless device to watch a video clip from some old TV show where the town doctor makes house calls while carrying his little black bag. Now, you can use that same device to virtually recreate that experience. Talk about 'full circle'. It began with remotely evaluating a patient which led to determining the need for a home visit and then ultimately eliminating a trip to the hospital. Reducing hospital re-admissions is the purpose that lies at the center of the telehealth movement, saving billions upon billions of dollars. Not only has the house call made a comeback but the very notion of the hospital visit is being redefined as well.
The House Call
House calls made up nearly half of all medical visits for the first half of the 20th century. Eventually, insurance carriers were unable to cover them and that number dropped to 1%. That was the 1980's, before two-way video, e-mail and smartphones. In the movies, computers were still playing War Games, fighting Superman or bringing Kelly LeBrock to life. To say that popular culture had no bearing on the real world application of the technology would be an understatement.
Now, like most everything else, the house call is an app you can download on your phone. Entrepreneurs have seen and met the demand for quality and convenient healthcare access. The brick and mortar model is giving way to mobile access. It is not, however, being replaced.
The Hospital Visit
Does the emergency room only handle emergencies? We all know the answer to that question. Plenty of visitors still seek treatment for minor ailments because they know of no other option. A telehealth screening will determine if the emergency room is even necessary. Furthermore, doctors making a house call can spend more time with their patient than they can in an urgent care setting.
Telehealth may have brought back the house call but not at the expense of the hospital. To the contrary, hospitals are already undergoing their own transformations based on the advantages of telehealth. Take Mercy Hospital in St. Louis, Missouri, for example.
In one case, the hospital supplied an 80 year old cattle farmer with an I-Pad. The hospital has its own Mercy Virtual Care staffers called "navigators" who are trained to ask him standard questions about how he is feeling and whether he has taken his medication. After one call in regards to a potential cardiac episode, the navigators were able to assess his vital signs remotely and recommend new medication. Another time, the man fell and thought he'd broken his rib. His wife saw that he could not breathe and almost called for an ambulance. Instead, she called Mercy and the navigators recommended certain movements that proved his rib was not broken and that he could, in fact, breathe. Home care followed.
Hospital without Beds
The point to take away is that hospitals are not going anywhere. They are just changing shape, as they always have, to reflect changing needs in healthcare. Mercy has simply allocated 330 staffers to their Virtual Care Center, which they describe as a "hospital without beds." From this $54 million command center, Mercy plans to operate its telemedicine programs.
The mission is connectivity between all ports of care. For example, a pilot program already exists to provide remote care to 250 patients with complex chronic illnesses, of which the cattle farmer is one. Continuity of care is maintained by communicating with their primary care physicians and ensuring that each patient sees the same navigator for each session. These days, the "little black bag" carries far more than a thermometer, a stethoscope and that little rubber hammer that tests your reflexes. Healthcare has simply come full circle, bringing the hospital to your home.