Doorbell could be nurse practitioner
House calls for kids are an option through pilot program
Sarah Rhea was out of town on a weekend business trip when her husband called, worried that their 4-year-old son’s fever, sore throat and cough were worse than the day before.
It sounded like it could be strep throat, which usually might warrant a trip to the nearest urgent care center. But the Rheas tried a handy new option, launched last month in The Woodlands: summoning a nurse practitioner to their home through an Uber-like smartphone app.
“She determined it was likely just a virus and definitely not strep,” said Rhea, executive director of a Montgomery County nonprofit. “But the great value was that it provided us peace of mind. That’s no small thing when your child is sick.”
The pilot program, a partnership between Children’s Memorial Hermann Hospital and a new Dallasbased startup called PediaQ, marries today’s technology-driven clamor for in-demand services with
the old-fashioned house call. Thanks to the tool, parents are able to quickly connect with nurse practitioners who can diagnose and treat common childhood injuries and illnesses during the off hours when pediatrician offices are typically closed.
There are a number of app-based services providing house calls in certain big cities — Pager, Heal, Medicast and Dispatch Health are the best known — but PediaQ says it’s the first to cater only to kids, not adults. It is the first of any kind of such services in Houston.
It’s also part of a broader ongoing effort, from telemedicine to walk-in clinics in retail stores, to make health-care more convenient to the patient. Memorial Hermann officials say their partnership with PediaQ marks “an evolution” in personal pediatric health and represents their latest strategy to “transform the way health care is delivered.”
Mixed reviews
Primary-care experts offer mixed views on whether the transformation is a good thing.
“PediaQ’s approach plays on notions of fear and the market rather than providing real added value,” said Dr. Stephen Martin, a professor of family medicine and community health at the University of Massachusetts Medical School. “If it was being offered to kids on Medicaid and the Children’s Health Insurance Program, it would be more compelling. But this is just getting people with money to pay for additional health care, monetizing what should be happening in primary care anyway.”
But Dr. Igor Shumskiy, a pediatric resident physician practicing at several Boston area hospitals and self-described house call advocate, said the Memorial Hermann-PediaQ program seems like “a great service that complements primary care.” He said the model — patients get quality care at home, the family’s pediatrician gets a report of the visit — is preferable to the family going to the ER, where the child may contract someone else’s infection and the doctor rarely gets a report.
House calls were commonplace in the U.S. in the 1930s and 1940s, but died out as medicine became more technologically sophisticated. By 1980, they had become just 1 percent of doctor appointments, according to the American Academy of Family Physicians.
PediaQ leaders in 2014 first saw the potential for the practice to make a comeback. Sensitive to parents’ cries for more care options during after hours and millennials’ push to obtain on-demand services, PediaQ determined nurse practitioners could be a great source of home care. Increasingly, they are being given authority to provide care as one solution to the nation’s shortage of doctors, projected to reach 90,000 by 2025.
Plans to go national
The company launched in 2015 in north Texas without a hospital partner; in 2016 in Waco with Baylor, Scott & White Medical Center as its partner; and in 2016 in Houston, initially without a hospital partner but now with Children’s Memorial Hermann. In that time, about a year, PediaQ nurse practitioners have provided more than 3,500 house calls in Texas.
The company plans to go national soon.
In Houston, the partnership is currently available only in The Woodlands and surrounding communities on weekends, with weeknights soon to follow. The plan is to expand services throughout the area if the pilot program is successful.
“For the last several years, parents have told us how nice it would be to have pediatric home visits,” said Dr. Victoria Regan, senior vice president for Memorial Hermann’s women’s and children’s service line. “Families today frequently have two working parents, parents who can’t always get to doctors the next morning like they’d like. This helps them plan their week and know what to expect so they won’t miss a lot of work.”
The service works as simply as Uber. Parents open the app, plug in their information and request a home visit. Within minutes a nurse practitioner will call for details and make sure the situation doesn’t warrant a trip to the ER. If the family still desires a house call, the nurse practitioner will arrive within an hour, armed with any necessary tests. The next day a visit report is sent to the family’s pediatrician.
If the visit is covered by insurance — PediaQ accepts BlueCross BlueShield, Aetna, Cigna and UnitedHealthCare — families pay a standard co-pay plus a $25 convenience fee (currently being waived). Without insurance, it’s $150 plus the fee. Any lab tests are extra. There’s no fee if a nurse practitioner doesn’t make a house call after the phone consult.
The program seems bound to be a hit with parents, but is it a good use of health-care dollars? The business moved away from house calls because it was more efficient to bring patients to doctors; enlisting nurse practitioners during off hours changes the equation a bit, but it will still tie up well-salaried employees in a lot of drive time. It’s also unclear if house calls will actually cut ER use: experts say studies have found that other “patient-friendly” ventures touted for having the same potential — telemedicine and retail clinics — don’t result in a decrease. They function as additions to health-care use, not replacements.
‘The inverse care law’
Martin extols the value of house calls for patients who are vulnerable, newly discharged from the hospital or with transportation challenges. But he says most after-hours house calls sought by concerned parents would be unnecessary, involving either mild illnesses, such as earaches and sore throats, that can’t be resolved overnight and can wait until the next morning; or more serious issues, such as neonatal fever and asthma flares, that need care at an ER or urgent care center anyway.
Martin says house calls for relatively healthy people is a perfect example of “the inverse care law” that characterizes so much of America’s health practices: “the less treatment you really need, the more you get; the more you need, the less you get.”
Shumskiy, who’s conducting research on the subject, thinks a cost-effective house call business model can be achieved for under served inner-city populations. Eighty-five percent of such families his team interviewed, he notes, said they would love telemedicine and house calls and would prefer them to going to the ER.
Shumskiy adds that a home visit, with its window into how the family lives, provides the practitioner more patient information and creates a bond hard to duplicate in the clinic. He also notes the primary benefit of many appointments at a doctor’s office is no different than that which families often get out of a house call — peace of mind.
“It made perfect sense to move away from house calls the past five decades, but this may be the perfect time to transition back to home care,” said Shumskiy. “We can run strep throat screens and blood tests at home. Low-acuity cases don’t need to come to the hospital or doctor’s office.”