BY JACLYN COSGROVE STAFF WRITER | Oklahoman
Each time Bob Littlejohn needed to go to the doctor, his wife had to call the fire department.
Bob Littlejohn, 77, of Oklahoma City, had a hip replacement about five years ago, but it got infected. Doctors had to remove the device, which left him unable to walk and homebound.
His family couldn’t fit a medical lift into the room where he stays, and his wife, Sallie Littlejohn, 74, and their daughter, Marcie, couldn’t move him on their own.
“Each doctor visit would cost me — off the top of my head — $2,400 for an ambulance, and it’s not covered by Medicare,” she said.
Sallie Littlejohn wonders if the days of worrying whether she would be sent to a collection agency because she couldn’t afford her husband’s care are over.
For the past five months, Bob Littlejohn has received his primary care at home through Physician Housecalls, an Oklahoma City company that hires primary care physicians who drive throughout the metro area, providing care to many homebound patients.
It is one of a handful of companies offering physician house calls, once thought to be a thing of the past. However, as technology continues to advance, doctors now can become increasingly more mobile, less dependent on having a brick-and-mortar office.
In the 1930s, house calls were standard practice for physicians, with doctors providing about 40 percent of visits in their patients’ homes, according to an American Academy of Family Physicians journal article.
But by 1950, this had fallen to about 10 percent, and by 1980, only about 1 percent of patient encounters were house calls, according to the article.
However, nationwide, a renewed interest is springing up for house calls, evident in Medicare Part B billings, which increased from 1.4 million visits in 1999 to 2.3 million visits in 2009, in part because of changes in regulations and a 50 percent increase in reimbursement, according to the journal.
The demand for house calls is expected to increase considerably as the U.S. population ages, according to a 2012 study published in the Journal of the American Board of Family Medicine.
Research has been inconsistent in showing how much money house calls save the health care industry and which patients most benefit from them, and also, in what ways they might benefit.
However, Hank Ross, owner of Physician Housecalls, said he’s confident that his company will save health care dollars. Medicare pays Ross’ company $133 per doctor’s visit. Doctors can see patients, which have to be homebound or unable to leave their homes for appointments, once every 60 days. Physicians can make house calls more frequently if the visit would prevent a trip to the emergency room, or if the patient has a significant change in his or her health.
For comparison, a trip to the emergency room easily would cost $2,300.
Ross said the service he’s providing will save Medicare and other insurers’ money — and more importantly, it will keep people out of the emergency room and receiving care in a place where they’re comfortable.
“I think this is part of the solution, not the problem,” Ross said. “I love what I do because we keep people in their homes.”
Sitting at the table in Littlejohn’s home, Dr. Joe Witten, a primary care physician, is sifting through paperwork.
Many doctors who provide house calls don’t have offices because of the cost of overhead.
Reasons for decline
The reasons why physicians largely stopped providing house calls is multifaceted, but a lot of the reason relates to insurance, cost and technology, said Jim Hess, Oklahoma State University health care administration school chairman.
Early in the 1900s a report, known as the Flexner Report, was critical of the increase in the number of medical schools in the United States, Hess said. This resulted in the closing and consolidation of a number of medical schools and ultimately in a decrease in the number of practicing physicians. Years later, the post-WWII expansion of the population, otherwise known as the Baby Boom, created greater pressures on the number of practicing physicians to be able to treat a growing population, Hess said.
Physicians used to make hospital visits, treat patients in their office and make house calls, all in the same day. Given the number of patients to be treated, something had to give, Hess said. In the 1960s, Medicare and Medicaid were enacted, creating greater reimbursement opportunities for physicians, followed quickly by the expansion of private insurance. These reimbursements made office visits reimbursable as opposed to just hospital visits, he said. Around this same time period, it was becoming increasingly more common for medical students to borrow large student loans to pay for medical school. After finishing school, they needed to repay those loans, and thus, needed to see as many patients as possible. Hess said in the 1960s and 1970s, practicing medicine became seen as a business as much as a profession. Put all these factors together, and house calls were practically gone.
However, as technology continues to advance, doctors could become increasingly more mobile, less dependent on having a brick-andmortar
office, Hess said.
Need for help
For years, Wesley Ercanbrack, 84, took his wife, Billie Jean, 80, to most of her doctor’s appointments.But it got harder and harder as her health worsened. Billie Jean Ercanbrack started showing signs of dementia a little more than 20 years ago.
In the beginning of the disease, Billie Jean would forget where she was, wander off and hallucinate. In 2008, she started forgetting her family members and friends. Then she stopped talking and couldn’t communicate. Soon after that, Billie Jean forgot how to chew.
While Wesley would feed her, she would forget to open her mouth. She has a feeding tube now.
“With all the diseases in this world, that one I don’t want because you lose your mind, you lose control of your body and everything,” Wesley Ercanbrack said. “I’d rather have anything and still have control of my mind and have my mind — it’s a horrible disease.”
At one point, their son asked Wesley Ercanbrack about considering a nursing home. That was not an option that Wesley Ercanbrack wanted
to consider for Billie Jean. They were high school sweethearts who sneaked off — while Billie Jean was 15 and supposed to be in class — to get married in McAlester at the Church of Christ.
“As long as I can put two feet before the Earth, she is going to stay with me,” he said. “We’ve lived together for 64 years, and as long as I can handle it, we’re going to be together.”
On a recent afternoon, Wesley Ercanbrack sat at the dining room counter and used a telemedicine device to check his vital signs. He regularly does this.
Thanks to Physician Housecalls, Wesley Ercanbrack also is able to receive some of his care without leaving Billie Jean.
She lies nearby in her bed, a brown recliner at the foot of her bed. That’s where Wesley Ercanbrack likes to sit, so that she knows he’s always there with her.
Billie Jean has a mass in her bladder, and doctors have said, because of her dementia and ailing health, an operation is not her best option.
Neither is chemotherapy, if the mass is cancerous.
She receives all of her primary care at home, and Wesley is usually close by, where he receives the occasional smile from her.
“I don’t know how she’s going to last with (the mass), but still and all, she’s doing fine,” he said. “That was a year ago when she was diagnosed with that mass in her bladder, and we’re doing just fine.”