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Cadence doctor makes house calls, takes page out of the past to change medicine

Published: Wednesday, Nov. 27, 2013 6:00 a.m. CDT

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A local doctor thinks the Affordable Care Act has created an opportunity for the past to take root again.

Dr. Tom Cornwell, medical director of HomeCare Physicians at Cadence Health Hospital in Winfield, believes that the future of medicine, and part of the solution for rising health care costs, could lie in making house calls.

Cornwell has made more than 31,000 of them during the past 20 years. He and his HomeCare medical team serve some of the most vulnerable and expensive patients in medicine – those who are elderly and homebound.

“My average patient is 80, and a third are over 85,” he said. “Because of their age, these are usually very, very sick people.”

About a quarter of the 800 patients he sees annually pass away, according to Cornwell.

Because they are at the end of their lives, he said, they often have much higher health care costs – a burden often placed on Medicare. Older homebound patients are much more likely to have frequent, expensive hospitalizations than other patients, he said. An ambulance ride alone can cost $1,000.

“For the top 10 percent of the Medicare population, the average cost to the system was around $55,000,” Cornwell said. “The remaining 90 percent was $4,584 per person. We are attacking those 10 percent.”

Most visits from HomeCare cost about $200. About $130 of that is paid for by Medicare or the patient, with donors and Cadence covering the rest.

“He allows patients to stay at home, receive excellent care, and then, in doing so, keeps them out of the emergency room, out of hospital settings and avoiding extra costs,” said Dr. Maurice Birt, a family practice physician at Cadence who often refers patients to HomeCare.

Birt said that Cornwell can conduct x-rays, labs and EKGs on-site, largely eliminating travel for check-ups. Instead of calling 911 when a patient is feeling ill, he said, they can call a HomeCare nurse or physician to make an assessment.

Jeanne Enright, a Glen Ellyn resident, said that Cornwell’s work with her mother, Betty Elliott, changed the trajectory of the last two months of her life.

As an octogenarian cardiac patient, Elliott occasionally felt weak or tired, Enright said. The independent living facility where she was a resident would often call paramedics to ensure that the spells of weakness weren’t serious. Her mother was hospitalized 13 times in a year, before Cornwell began caring for her last April, Enright said.

Cornwell was able to reduce Elliott’s overlapping medications and provide check-ups, allowing her to stay at home during a bout of pneumonia.

She went from being a “puppet” to being awake and aware during her last two months, Enright said, which let them make the most out of their time together.

“It was just a wonderful, wonderful time,” she said. “Was she still sick? Yes. But was she back to being Betty Elliott? Yes.”

Cornwell credits Cadence for funding the program, despite its directly costing them some of its most lucrative patients. But under the Affordable Care Act, that rate of return might change.

The health care bill penalizes hospitals where a high number of patients are re-admitted in 30 days or less by reducing Medicare funding.

According to the American College of Emergency Physicians, about 20 percent of Medicare patients are readmitted to a hospital within one month of discharge. When patients are allowed to receive longterm care at home, readmission decreases by 60 percent, Cornwell said.

He was recently named the president of the National Academy of Home Care Medicine and has been speaking to groups around the country.

Cornwell said his dream is to make end-of-life home care as commonplace as hospice care.

Enright said that when her mother died, she did so in her favorite recliner surrounded by family and friends. Now, she has been telling Elliott’s story to others in the hopes of helping Cornwell achieve that dream.

“She went from getting awful care that was very costly to getting great care at a fraction of the cost,” she said. “How is that not available to every single person?”

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