Back in the day, most people did not go to the hospital, as the hospital was the place for the very poor and impaired. Instead, they had physicians visit them at their homes. In the 1930s for example, 40% of physician encounters were at patients’ homes. As hospitals, physician offices and multi-physician practices started thriving and as transportation improved, more and more patients traveled to seek their care, and fewer doctors made house calls. Only 1% of physician encounters in the 1980s were house calls.

However, lately, there is evidence that physician house calls are back. Studies show that between 1998 and 2004, house calls to seniors on Medicare increased by 40%. And it seems that trend is likely to continue as Medicare makes it easier for physicians to get paid for house calls.

Two main differences exist between house calls of our days and those of the old days. First, the majority of house calls nowadays are for people who are home-bound due to multiple chronic conditions, such as diabetes, heart disease or Alzheimer’s, rather than for the general population. It is very hard for these patients to see their doctors on a periodic basis to make sure that their conditions are kept under control. So if they don’t get appropriate periodic care, they might end up in the Emergency Room.

Another major difference is that today’s technology allows physicians to check patients at their homes using portable X-ray machines, laptop-based tests and EKG, compact ultrasounds, and other small diagnostic devices that were not available in the 1930’s.

Not only do house calls have the potential to provide continuous care to elderly patients that otherwise would not be able to get it, but it can also dramatically reduce costs. While a visit to the ER costs up to $2,000, a house call costs only $100. Other countries understand that. In the Netherlands, for example, after-hour clinics are staffed by doctors who make house calls to patients in an effort to reduce ambulance use and emergency room visits.

In the current healthcare reform’s quest to improve quality and reduce costs, bringing house calls back seems to make a lot sense. The question is whether there will be enough financial incentives for the physicians to get in their car and do the rounds.