|By Tammie Smith, Richmond Times-Dispatch, Va.|
"When's the last time you took your metolazone?" Payne asked, referring to a drug that treats high blood pressure and fluid retention.
"You were pretty swollen the last time I was here," Payne said later. She reminded Peterson of the need to watch her salt intake as she did a hands-on exam, where she noted the swelling in Peterson's left leg and foot.
Typically such an exam would take place in a medical office, but Payne handled it in the living room of the
Mrs. Peterson, 57, who needs a wheelchair to get around, is thankful that Payne, a nurse practitioner who works for
"House Calls has been a blessing to me. It really has," Peterson said, recalling at least a couple of instances in which she missed doctor's appointments because van transportation didn't show.
The concept of medical house calls might bring to mind black-bag-carrying rural physicians. But under the modern version, the federal
The Medicare Independence at Home initiative is funding demonstration projects in 15 individual medical practices and three group efforts across the country. The programs will voluntarily enroll up to 10,000
"We will be rewarded if the patient's quality of care is maintained but their costs go down, said Dr.
"That's what we expect. Because we will be able to get to them quickly when they start to feel bad and help them stay on a more steady path, they will spend less time in the hospital, which is safer and better for them," said Boling, a founding member of the
VCU has operated its House Calls program for more than two decades, and Boling, who heads the program, has championed the idea of home-based care for frail patients.
For the demonstration project, VCU is partnering with two other institutions _ the
Each of the programs in the consortium has its own group of providers, but collectively they will enroll up to 500 patients.
Boling said there are three physicians making house calls and nine nurse practitioners. The program has recently added a social worker, office nurse and data analyst and will soon add another nurse practitioner.
Payne said clients typically live within 15 miles of
"Will you call me on Monday to let me know how the fluid is doing?" she asked Peterson during her visit. If everything stayed the same, she said she would be back in two weeks.
Boling said VCU's target is to enroll 150 to 200 patients. To qualify, patients must be covered by
If the demonstration projects are successful, it could change the
"We've designed it so that lots of programs could get into this type of model without having a lot of cash and backing and changes in structure of insurance programs or other things that are barriers to entry," Boling said.
"That is one reason why so many of the advanced geriatric care models have not advanced," he added. "It costs so much and you have to have so many resources and structures in place to start programs. We wanted to avoid that, and we wanted to target these programs and design them specifically to take care of people who are very frail and old and at risk."
(c)2012 Richmond Times-Dispatch (Richmond, Va.)
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