- Del Meyer, MD - https://delmeyer.net -

Home Visits

When I went into practice in 1970, I made home visits to tracheotomy patients too sick to come in to the office. I remember one patient who had been hospitalized in the ICU at the cost of tens of thousands of dollars. I then visited her every three weeks for tracheal changes, about 17 visits a year, which kept her out of the hospital for years. As I recall, Medicare and Medicaid didn’t even pay me that $15 a visit, or less than $300 a year, that saved them over 100 times that amount for just one hospitalization.

With cost containment, home visits are in vogue again. However, hospitals are conducting them this time. I still make home visits to my respiratory failure patients on life support, changing the trach every three weeks, and Medicare does pay me about $85. However, they pay the hospital over $115 for a nurse visit. Dr Davis wrote a letter to Medicare and asked why. Medicare wrote back saying the hospital has to pay the nurses salary, the car expenses, and other overhead. Dr Davis wrote back that he had the same expenses, so why couldn’t he get paid the same as the hospital nurse? Medicare never wrote back.

Doctors just don’t talk administrative language very well. Administrators from the HMO talk to the administrators of the hospital and each feathers the other’s nest.

How do the hospitals drum up this business? When I discharge a patient, the hospital discharge planner asks for a Home Health order so the hospital can make home visits. To avoid retaliatory action, most doctors write the order. However, patients frequently tell me there is nothing useful that they can see that the home health care nurse does. Even when they tell the nurse not to come out, the nurse will make one or two more visits.