Dr. Thomas Cornwell has made about 32,700 house calls in his career. In fact, he had eight last Monday alone, one involving a patient who had been in and out of the hospital from February to June. When she started receiving house calls from Dr. Cornwell, July became the first month of 2017 in which she spent no time in the hospital.
Seeing firsthand how beneficial home-based care is for patients and their families, Dr. Cornwell founded the Home Centered Care Institute in 2012. On Aug. 1, HCCI launched eight Centers of Excellence for home-based primary care across the U.S., at institutions like the Cleveland Clinic, Icahn School of Medicine at Mount Sinai and University of Arizona Center on Aging.
“We really are on an ‘A+’ list, and that’s because we are national leaders in the field,” said Dr. Mindy Fain, co-director of the center on aging; division chief of geriatrics, general internal medicine and palliative medicine; president of the American Academy of Homecare Medicine and board member of HCCI. “We really have been instrumental both in creating models of care and providing the education.”
Fain said all medical students completing their residency at UA receive some training in home-based care. The new, more extensive center is open to physicians and other medical professionals as well, and is offered free of charge to UA medical students and residents. The three-part training curriculum includes classroom education, group mentorship and a “mini-fellowship” program at an HCCI partner site.
“We need the Centers of Excellence not only to increase the workforce, but to improve the trained workforce,” Fain said.
Dr. Fain, along with Dr. Monica Vandivort and Dr. Corinne Self, both assistant UA professors, will teach the curriculum at the center.
“The three of us have a passion for home-based care for the elderly,” Self said, “As the three home-based care doctors, it was only natural that we would be the ones to teach.”
Like Cornwell, Fain initially became involved with home-based care because she wanted to help patients more effectively. But the icing on the cake, she said, was that home-based care has been shown to be extremely cost effective.
A Medicare demonstration program called the Independence at Home Act found that providing home-based care for eligible beneficiaries through participating practices saved participants approximately $32 million over two years, at an average savings of over $3,000 per beneficiary the first year and $746 per beneficiary the second year.
The cost-saving benefits of home-based healthcare are just one of the reasons Fain said she believes the Center of Excellence could boost the local economy. She also pointed out that offering assistance to family members acting as caregivers can allow family members to go back into the workforce. Physicians coming from out of state for the opportunity to learn at the center could be further additions the workforce.
Economic benefits aside, most terminally ill patients indicate a preference for dying at home, according to a 2005 study published in the Journal of Palliative Medicine. Cornwell spoke about the relief that professional home-based care can offer families, who are trying to do the job of medical nurses with little to no training.
“Everybody wins,” he said. “The patient gets what they want, the family gets support – they actually get a year of bereavement support after the patient passes away–and it saves a lot of money.”
Fain agreed, saying that a movement toward home-based care is “a no-brainer.” So why did the healthcare system move away from this model in the first place? Cornwell cites the rise of technology.
When innovations like X-rays were first developed, Cornwell said doctors couldn’t carry the equipment around to make house calls. But, today’s technology allows physicians making house calls to offer services comparable to most standard doctor’s offices, including running X-rays on portable machines, diagnosing conditions like pneumonia and blood clots and even starting treatments for those conditions.
“This is not just your typical black bag with your stethoscopes,” Cornwell said.
Within his modern toolkit, a device manufactured by AliveCor allows him to take patients’ EKG readings using an affordable, pocket-sized device and a smartphone application. In fact, he used it just the other day to detect an atrial defibrillation in a patient.
“She was from Italy, grew up in the war, had a beautiful garden, but she couldn’t get out [of the house],” he said.
Cornwell said that the vast majority of his patients suffer from chronic conditions such as ALS, MS, cervical spine injuries or muscular dystrophy. A smaller number are what he called “high-utilizers.” For example, one patient had 44 emergency department visits and 27 hospitalizations (half of which were in the ICU) in a 21-month period. In the first year of receiving home-based care, the patient was only hospitalized once. In the second year, the patient was not hospitalized at all.
“I always enjoyed taking care of what I call disenfranchised patients,” Cornwell said. “[These patients] are disenfranchised from the healthcare system because they can’t get to it. So instead of having them come to their office, which they can’t do, we bring the office to them.”