EmeraldCare_LogoEmerald care is a start up that brings Doctors, Nurse Practitioners and skilled medical workers directly to a patients home.  The good old days of a house call are making a comeback in America and Emerald Care is bringing that service to Tucson patients. Emerald Care’s primary focus is on skilled care homes.

The Future History of Home Care and Physician House Calls in the United States

Bruce Leff a , b and John R. Burton a

Over the last 20 years, home care has experienced significant change. The home care industry developed into big business and a number of innovative models of home care were developed and evaluated. Although physicians perform many fewer house calls than a half-century ago, there has been a recent revival in house-call training, education, and practice. In addition, telemedicine and other technologies hold great promise for the future of home care. However, the future history of home care will depend mostly on the ability of various stakeholders in the health care system to recognize the value of home care and develop and implement the appropriate incentives to encourage its proper place in the U.S. health care system.

THE image of a physician delivering care to a sick patient at home is one of the essential and enduring images in the collective consciousness of medicine. It is an image that no doubt once inspired, and perhaps still inspires, some to pursue a career in medicine. It is an image from which the medical profession, as a whole, once drew inspiration so as to say “Yes, this is what physicians are about. Physicians take care of patients.” However, more recently, when physicians tell colleagues that they make house calls, they may be looked upon as Luddites. More surprising is the reaction from patients in need of a house call when told they can be seen in their home: “I didn’t know anyone did that anymore.”

It is fascinating how quickly this transition occurred. A mere 50 years ago, house calls accounted for 40% of all physician-patient encounters (1). By 1980, house calls accounted for only 0.6% of such encounters (2). The shift in site of care delivery from the home to clinics and hospitals was the result of an explosion of biomedical knowledge and technology, increased access of patients to a growing medical system, the growth of third-party payers, and heightened liability concerns (3). In this article, we will discuss recent history and current developments in home care in the United States and then speculate on the future history of home care in America. Semantics in the area of home care have always been a challenge. We will use the term “house calls” to refer specifically to physician house calls and models of home care that include a substantial physician component; otherwise, we will use the term “home care,” with the understanding that there is often substantial overlap between the two areas.