American Academy of Home Care Physicians
Promoting the art, science and practice of medicine in the home.
1999 Vol. 11 No. 4
Issn# 1049-0028

Questions... and Answers - How Many MD Home Visits Are Required?

Dear Academy: I need some advice as to how I can measure the number of visits that a visiting physician needs to see his patient. My mother, age 82, will not leave the house, is physically very healthy (except for blood pressure and dementia). I found an agency which supplies a doctor who makes house calls and wants to come by at least once a month. At the last minute, there are phone calls as to when he is coming wants to do lots of tests. I don't want to dissuade him from coming for fear my Mother will end up with no doctor. Would like to have some advice as to the manner in which I need to be gracious and yet be able to somehow discern what is necessary for the ongoing medical needs of my Mother. Perhaps someone can help. My thanks, Ed Gembka

Reply: The answer to your question is both simple and profound. The number of visits and tests necessary for your homebound mother, whom I presume to be of Medicare age, is defined by Medicare regulations as what is "medically reasonable and necessary." Of course, the physician's role in determining what is "medically reasonable and necessary" must be based on professionalism and your trust.

The periodicity of house-calls has never been studied, but some recommendations and observations can provide guidance. The American Geriatric Society has published statements that the care of geriatric patients in the office, which presumes a mobility and mental status that may be quite a lot better than your mother's, requires 10-12 visits per year, or roughly once monthly. A unique frail elderly practice in Orange County, California supported by For Health corporation, assumes complete financial risk for their patients, paying all costs of care, whether in the hospital or not. They have told me that over the past five years, they have found the most dramatic reduction in overall cost of care is not achieved until they average NINE visits monthly to this population. Their patients may be sicker and more infirm than your mother, as all of their patients qualify for placement in a skilled nursing facility.

In summary, it is reasonable to expect monthly visits for treatment of dementia-related problems, monitor the many chronic conditions of the elderly, and to prevent untoward medical events; however, the intimacy and power of the physician house-call comes from the mutual trust that must be the foundation of all quality care. If you feel your physician is not providing services based upon what is "medically reasonable and necessary," you are encouraged to discuss your issues with the doctor and expect frank and understandable explanations.

- Gresham Bayne, MD