BY TIM BONFIELD
The Cincinnati Enquirer
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By a couch, Dr. Halina Harding can assess home situations as well as her patients' physical well-being.
(Tony Jones photo)
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As she walked up to a small brick home in Delhi Township on Friday morning, Dr. Halina Harding revived a tradition Greater Cincinnati hasn't seen in years: a doctor who makes house calls.
It was the first patient visit for the newly opened Cincinnati office of the Visiting Physicians Association (VPA), a fast-growing medical company that started in Michigan in 1993 and has recently opened seven offices in Ohio.
The agency specializes in sending doctors to the homes of people who cannot get to a doctor's office: the frail elderly, the disabled and others who cannot travel.
In this case, the patient was an elderly woman who recently suffered a stroke. She has been looking for a doctor who makes house calls, because her balance is so shaky she needs assistance from family and fellow church members just to get out of the house.
But Dr. Harding kneels beside the woman's couch rather than expecting her to get dressed, negotiate a walker down steps to a car, then travel to a glassy suburban office and back home again just to get a checkup or a routine follow-up test.
The Cincinnati-area agency, based in Norwood, is the seventh Ohio office opened in the past few months. Others are in Dayton, Columbus, Toledo, Cleveland, Akron and Youngstown. The company also has eight offices in Michigan, two in Florida and one in Puerto Rico.
Although starting with only one local doctor, managers expect quick growth because the service has been popular in other cities. In Detroit, for example, the Visiting Physicians Association grew to 46 doctors within three years.
"For most doctors, it's not feasible to do house calls on a routine basis," Dr. Harding said. "The advantage of this organization is that's all they do."
Cincinnati, like many cities, has witnessed swift growth in the availability and sophistication of home health care services. But until now, those services typically involved nurses or home health aides.
The typical VPA visit includes a doctor and a medical assistant. They come equipped with blood-pressure cuffs, portable cardiac monitors and gear to collect blood samples for diagnostic tests. Most important, the visit involves a fully trained doctor who can see and touch the patient, see and smell the home conditions, even check the medicine cabinet for signs of harmful drug interactions. In theory, patients at home will be comfortable and confident enough to give complete answers and ask more pertinent questions about their care. In theory, doctors will be better able to assess whether patients are getting the right level of care.
The for-profit company works by paying doctors by the hour and by keeping office expenses low while billing Medicare and Medicaid for medical exams and diagnostic tests. So far, coverage by private insurers and managed care health plans has been mixed, but growing. VPA's medical teams generally visit eight to 15 patients a day, far fewer than the 30 or more patients a day an office-based physician might see. The pace may not be as fast as some doctors prefer. But the trade-off is less involvement in the business side and business costs of medicine.
"Medicine is much more of a business than it used to be. A lot of my colleagues complain about the hassles of billing and computers and staffing and benefits. This is a wonderful way to mediate that problem," Dr. Harding said.
The doctors VPA employs are usually family practitioners, general internists and others focused on geriatric care.
In Cincinnati, the company is negotiating with several doctors to be full-time participants as patient volume grows. Dr. Harding, director of the family practice residency program at Grandview Hospital in Dayton, is working part-time for the agency until it becomes more established.
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