Anne Hayes sat in her car sobbing. She’d just arrived at a doctor’s appointment for her 1-year-old twins, Vivian and Audrey, both of whom were born several weeks early and had spent more than three months in the neonatal intensive care unit. Audrey, who weighed just under 2½ pounds at birth, still required a feeding tube and had to eat on a strict schedule. So before heading inside to see the doctor, Hayes had connected a syringe to the tube and prepared to squeeze the baby formula into her tiny daughter’s stomach. But the tube became dislodged and the formula spilled everywhere.
Hayes remembers breaking down, overwhelmed by the stresses of managing her children’s medical problems and the logistics of taking three young children to an appointment. Her 3-year-old son, Ryan, who had endured several surgeries to repair a congenital heart defect, was old enough to be concerned but too young to be much help. She still hadn’t gotten out of her car. The twins were crying.
“It was a low moment,” Hayes says.
A little more than a year later, Ryan is jumping up and down on the couch, displaying energy typical of a 4-year-old who’s cooped up at home with his mom and sisters on a rainy morning. He flops down on his back and lifts his shirt, exposing a scar down the center of his chest.
“Can you measure my heart? Can you check it?” he asks the family’s pediatrician, Dr. Ashley Moss, who has come to their house in Chevy Chase to check on him and his sisters. Moss has built her entire practice around seeing patients in their homes. Before meeting her, Hayes didn’t know such a practice existed, and she thinks it’s saved the family countless trips to doctors’ offices, urgent care centers and the emergency room.
In the living room, Moss examines Audrey’s ears while Vivian plays with one of her toys on the floor nearby. Ryan runs to another room, returning a minute later with a pretend stethoscope in his hand.
“Can I help you, Dr. Moss?” he asks.
Just over a mile from the Hayeses’ house, Moss has a desk in the small home office she shares with her husband, David, an orthopedic surgeon she met when they were both undergraduates at Princeton University in New Jersey. But she doesn’t have any exam rooms or staff, and most of her work is done on the road: in her car between appointments, at kitchen tables and on families’ couches, even in another doctor’s office. She sometimes joins patients when they go to see a specialist—she once accompanied Hayes on a visit to Audrey’s gastroenterologist to make sure everyone was on the same page.
Moss, 42, opened her practice in January 2017, after nearly nine years with Potomac Pediatrics in Rockville. The mother of three children—now ages 6, 8 and 11—she was looking for a way to have more flexibility in her schedule but also to spend more time with each of her patients and their families. Initially she thought she’d open her own office-based practice, but after speaking with a few pediatricians in Dallas and Atlanta who were traveling to patients’ homes, she decided to try the model herself.
“It’s been even more rewarding than I could’ve imagined, being able to deliver the kind of care that I wanted to,” she says.
Many families are willing to pay extra to see Moss, knowing they can get her on the phone when they need after-hours care—and that if necessary, she’ll come to their home—rather than dealing with a doctor’s answering service. Hillary Wilner, a Chevy Chase mother whose sons are 2 and 4, likes that she can get more work done while waiting for Moss to come to her, rather than having to take half a day off to bring her kids to the doctor. “I felt I was spending so much time at the [pediatrician’s] office,” says Wilner, whose children have been Moss’ patients for about two years. “As a mother, it’s tough to make an appointment, take a sick child out of the comfort of their home, and take them and their sibling into a doctor’s office. Additionally, having her come to the house for well-child checks eliminates exposing my children to sick, contagious children.”
Moss is among a small but growing number of medical providers who see patients in their homes, and one of the few pediatricians in Montgomery County doing it. A number of factors are contributing to the popularity of house call practices, including more access to the physician, longer visits and the convenience of not having to find parking or having to sit in a waiting room. Before starting her own practice, Moss says she saw 20 to 26 patients during a typical day in the office. Now, a busy day for her means seeing five children, and she often spends more time with each patient than the 15 to 20 minutes she was usually allotted for appointments in the past.
Most house call practices focus on treating elderly patients who have a difficult time getting to office or hospital appointments, says Dr. K. Eric De Jonge, president of the American Academy of Home Care Medicine. For those patients—and the organizations that pay for their care, such as the Centers for Medicare & Medicaid Services—avoiding steep medical transportation and hospitalization bills makes the cost of home visits worth the investment, both in terms of receiving better care and reducing health care expenses.
But convenience and cost savings aren’t the only reasons home-based care is popular, De Jonge says. “The more powerful benefit, both to the providers and the patients, is the closeness of the doctor-patient relationship and the trust and knowledge you acquire by seeing patients in the home.”
Home visits give doctors the opportunity to see certain aspects of patients’ lives with their own eyes. They might recognize hazards such as loose rugs or cords that can increase the risk of tripping and falling. Performing a “kitchen biopsy,” as De Jonge calls it, can reveal an abundance of high-sodium foods in the home of a patient who has congestive heart failure. A physician could notice that a patient has prescription bottles for six blood pressure drugs from three different doctors, which can lead to life-saving changes in medication routines.
For Moss, it’s helpful to experience a child’s home environment and gain firsthand knowledge of the family situation. She gets to meet any pets in the home, and even check on a child’s sleeping arrangements. “We ask [about] all these things in the office,” she says, “but being able to see it, and being there, is tremendous.”