There's a Doctor in the House

It's a new-old idea: Physicians who don't make you come to them-they come to you

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On a sunny, early fall afternoon, the navigation system in Dr. Amy Schiffman’s crossover SUV guides her to the contemporary-style home of an elderly widow in Chevy Chase.

“How’s our lady doing?” Schiffman asks the certified nursing assistant who answers the door.

Schiffman follows the nursing assistant to the master bedroom, where the lady in question is stretched out under a plaid blanket on a king-size bed plump with pillows and scattered with newspapers and magazines.

“Do you remember who I am?” Schiffman asks her patient, who is 85 and suffers from dementia.

The woman appears mildly puzzled. “I remember,” she says, “but I don’t know why.”

She sits up and swings her bare legs over the side of the bed. Schiffman and the nursing assistant, who cares for the woman during the day, are worried about her persistent, hacking cough. So Schiffman takes the stethoscope from around her neck to listen to her patient’s chest.

“You don’t have happy lungs,” the doctor says.

Schiffman clips a pulse oximeter to the woman’s index finger to measure her blood oxygen level. It’s 88 percent. Any lower and the woman will have to go on oxygen, Schiffman tells the nursing assistant.

The patient dismisses the notion and assures Schiffman that her cough will go away. Still, the doctor will seek the advice of a lung specialist.

Schiffman is among a handful of local physicians who are bringing new meaning to the phrase “there’s a doctor in the house.” They might seem like a throwback to a simpler time in medicine, but doctors who make house calls actually represent a growing trend, due in part to the aging population.

The number of house calls paid for by Medicare has increased every year since 1999, when it was nearly 1.5 million, according to the American Academy of Home Care Physicians. In 2011, Medicare paid for just over 2.6 million house calls.

“It is so much less expensive, and it is what patients want,” says Constance Row, executive director of the home care physicians group, which is based in Edgewood, Md.

At the same time, an increasing number of concierge medicine practices are offering house calls to patients in wealthier parts of the country, such as Bethesda, Row says. These people are willing to pay out of pocket for the convenience.

From the time she launched her practice in May 2011 until this past fall, Schiffman made more than 1,500 house calls throughout Montgomery County and Washington, D.C. Virtually all of them were Medicare patients, but she has a handful of private-pay patients, too.

“It’s about rediscovering medicine,” says Schiffman, who had spent most of her career as an emergency room doctor with fancy high-tech medical machinery at her fingertips and a battalion of medical specialists at her beck and call.

Schiffman's house-call tote isn't your typical black doctor's bag. Photo by Laura-Chase McGeheeThese days, her goal is to keep patients out of the emergency room. Her equipment fits inside an L.L. Bean “boat and tote” bag personalized with “Dr. Amy” in blue embroidery, and she does as much as she can in patients’ homes without bringing in other health care professionals. Schiffman says Medicare pays her about $210 for a house call to a “complicated” patient. She charges $300 and up for her private-pay patients.

A Bethesda resident, Schiffman originally made the switch to have more control over her schedule and her practice. She’s married to an OB-GYN and the mother of two elementary school-age children. “I wanted to do my own thing,” she says.

So she Googled “house calls” and hit upon the MedStar Washington Hospital Center Medical House Call Program, which was created in 1999 to serve elderly patients who live near the hospital. She tried it out by accompanying Dr. George Taler, a geriatrician who co-directs the program, for a couple of days. “He looked at me and said, ‘Amy, you can do this.’ ”

Now “I’m part social worker, I’m part doctor, I’m part family caregiver for those who have no family,” says the 43-year-old Schiffman, who grew up in Durham, N.C., the daughter of two Duke University psychologists. “I want to solve the hardest problems, and I can’t think of doing that any other way.”

Like Schiffman, Bethesda resident Dr. Susan Miller began making house calls so she could set her own schedule. After completing a geriatric fellowship at George Washington University in 1990, Miller had a typical office practice in Friendship Heights and Chevy Chase, Md. But in 1998 she closed the office in order to give her more flexibility for her children and doctor-husband, and began doing house calls and nursing home visits exclusively.

On a house call, Miller can check to see whether a patient has food in the refrigerator or an excessive number of pill bottles in the medicine cabinet.

Also like Schiffman, Miller accepts Medicare. But because Medicare doesn’t reimburse for travel time, she began to concentrate six years ago on nursing home visits, and her house call practice dwindled to about a dozen patients.

“I was so glad when Amy [Schiffman] actually started seeing patients, because I was turning patients down all around,” she says.

About a year ago, Miller became a consultant for Encompass Meds, a doctor-owned, Bethesda-based company that manages home care for elderly patients, and started making more house calls. An empty nester at 56, Miller says she “can afford to work a little bit harder” now.

Miller likes having the support of the Encompass Meds team, which includes a dietitian and social worker. A medical technician accompanies her on calls, so while she’s talking with the caregiver, the tech can perform tasks such as checking the patient’s list of medications. Encompass Meds charges patients a one-time fee of $450. Then Medicare pays her for each house call.

Because of traffic, Miller tends only to see patients in Bethesda, Potomac, Kensington and Chevy Chase. She also provides in-home hospice care through the Jewish Social Service Agency.

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