Bringing hospital care to patients

Before Bartlett resident Celina Brose had a stroke six years ago, her husband, William, took her everywhere.

“She won’t stand now. I did it all by myself before,” William said. “I took her everywhere — to the beauty shop, to the mall.”

But now that Celina uses a wheelchair, in order to get her out of the house, William would either have to call for transportation or purchase special equipment or a vehicle.

To make things easier, Dr. Paul Chiang has been coming to the Broses’ house for several years, visiting every three months.

“Just look around — the richness of being in the home. You learn so much about a patient and their family from being in their home,” Chiang said. “The good and the bad; if they are cared for or if they are alone.”

Chiang’s trips to the Broses’ home are among the more than 15,000 home visits he has made to patients in need during the past decade of his career through nonprofit practice HomeCare Physicians. With the support of Central DuPage Hospital and private donations, HCP has been traveling a 300-square-mile area surrounding Winfield-based CDH since 1997 to treat elderly and disabled patients who have difficulty leaving their homes — a service that hasn’t been widely offered for more than 60 years.

“There are doctors in clinics, nursing homes and obviously hospitals,” Chiang said. “But not in the home. This is great medical care minus the inconvenience they would encounter if they had to leave the house.”

HCP is composed of founding physician Dr. Tom Cornwell, Chiang, advanced practice nurse Ancy Zacharia and three certified medical assistants. In addition to convenience, the practice saves patients costly ambulance trips, emergency department visits, hospitalizations and premature nursing home placement.

A recent article from The Journal of the American Medical Association showed the first documented increase in home care visits since the 1930s. From 1930 to the 1990s, home care visits fell from 40 percent to less than 1 percent. But from 1998 to 2004, the annual number of house calls increased by 43 percent.

Comfort of home
Certified Medical Assistant Kristen Monforti has been with HCP for seven months. After many years of working in a cardiologist’s office, she decided to also become a part of the HCP team when her parents passed away.

“Both of my parents passed away within three years of each other,” Monforti said. “I took care of them throughout. And that’s when I decided this is what I wanted to do.”

The average age of HCP patients is 80. Most have neuromuscular conditions such as multiple sclerosis, muscular dystrophy, Lou Gehrig’s disease, or spinal injuries.

Chiang said another benefit of home visits is a doctor’s ability to acquire an additional understanding of the patient’s hobbies, family and diet.

The Broses celebrated their 60th wedding anniversary Nov. 12. In addition to the countless family photos on the cabinets and walls, the house was decorated with celebratory balloons and roses when Chiang and Monforti visited the Broses Nov. 13.

“The patients are in their comfort zone,” she said. “They are not as scared. A hospital is such a foreign place and they don’t know what’s going to happen to them. This is warmer and patients are much more appreciative.”

Possible savings
In addition to its unique personal care, HCP’s services also are affordable, the group said.
Cornwell notes in 1998, there was a Medicare increase for reimbursement of home visits.

“Prior to 1998, payments under Medicare were half of what they are now,” Cornwell said.
With Medicare picking up 80 percent of the costs, public aid frequently pays the remaining 20 percent.

“Most patients do not have to pay out of pocket,” he said. “And at most, its 20 percent of the bill.”
Cornwell said other health care systems have not embraced practices such as HCP because they would lose money on the program.

“Our No. 1 priority is to keep people out of the hospital. I’m so proud that I work for health system who is willing to lose money,” Cornwell said. “To keep business away from them shows how willing they are to help the community.”

With 95 percent of its patients older than 65, HCP treats people who are considered the sickest 10 percent of Medicare patients and consume about two-thirds of its budget. Encouraging house calls to that population could cut Medicare costs substantially, said Cornwell. That’s why he is excited about The Independence at Home Act, which is a provision in the U.S. House of Representatives’ health care reform package that he says would not only decrease health care costs, but also improve patient satisfaction and outcomes.

“We are starting to be heard on Capitol Hill, and it will curve the cost of health care to the aging society,” Cornwell said.