Mobile Medicine: House calls make a comeback

Record-Eagle/Nathan PayneNurse practitioner Julie Hartl checks Ann Hanson’s vital signs during a house call to Hanson’s Interlochen home. Hartl is among few medical care providers in the Grand Traverse region who make house calls, but she expects her business will continue to grow.

TRAVERSE CITY — It took only a moment for Ann Hanson to prepare for her morning medical checkup.

Her Princeton University socks peeked from under the edge of her slippers — she remained seated in her reclining chair, bundled in a warm shawl. Nurse practitioner Julie Hartl knocked softly on the front door of Hanson’s Interlochen home before stepping inside.

Hartl is on the front edge of what she expects to be a growing trend toward health care professionals making house calls, taking the office on the road much like their predecessors did 100 years ago. Hanson was the first patient to sign up after Hartl launched her business, Chronic Care Management, last April.

Going mobile

Hanson and Hartl started their 10:30 a.m. appointment with the usual greetings while Hartl slipped off her shoes and took a seat on a couch adjacent to Hanson. She unpacked a stethoscope, a blood pressure cuff and an iPad while they spent a few minutes catching up.

“This was from Christmas,” Hanson said, handing Hartl her latest family photo.

The appointments move a little slower and lack the formality typical of office visits. The relaxed atmosphere often allows patients to share more in-depth information about their condition, Hartl said.

At least one doctor has criticized Hartl for getting too close to her patients, she said. But listening to people and learning about their lives is something she learned early during her 10 years working as a nurse.

”They won’t talk to you if they don’t trust you,” Hartl said.

Hanson spent more than a year fighting cancer. She credits Hartl’s checkups with keeping her both alive and out of the hospital.

Her primary care doctor suggested she give Hartl’s mobile medical practice a try. Constant trips to doctor’s offices and the hospital were wearing on Hanson and eventually detracted from her quality of life.

“I was going out every day for radiation,” Hanson said. “It’s a chore to get out. To not go out all the time ... it’s just better. It makes my days so much better.”

She still needs to leave the house for visits to specialists, but Hartl handles smaller ailments and keeps her medication dosages well-adjusted. The convenience costs the same copay as office visits, Hartl said.

“This is wonderful,” Hanson said after Hartl listened to her lungs and recorded some notes on her iPad.

Filling a care niche

Not many doctors make house calls, but there is no shortage of need for them, Hartl said.

Debra Graetz, a family practice doctor in Traverse City, is one of a handful of physicians who make house calls in the area. It’s a part of the profession she embraced while working at Munson Medical Center during her residency, and one she employs seven years later.

Her practice isn’t taking new patients, but Graetz estimates she makes a house call for one of her patients about once a month.

”If one of my patients would be better served by a home visit rather than coming to my office and I can go, I do,” Graetz said. “The way that I do it I don’t believe is common. I don’t think there are a lot of doctors lining up to make house calls. I do it because it is right and it feels right.”

A few companies across the U.S. cropped up recently offering medical professionals who make house calls, including one in Detroit. Any doctor can make house calls, but the structure of the health care system keeps the trend from spreading quickly, Hartl said.

House calls benefit certain types of patients more than others, particularly those with dementia, Graetz said. 

”It’s a very calm experience,” Graetz said. “Generally I’m offered a cup of tea ... and I get to see the actual situation that led to their falling or their sore. It gives me a more full view.”

Hartl previously worked for Munson Medical Center’s palliative care program before it stopped offering home visits. Her practice took what she learned treating patients in their homes for end-of-life care and ran with it. 

Hartl said the niche isn’t just good for patients, it appears to be a growing segment of the healthcare business as more Americans age and begin to struggle with costly ongoing health problems that demand more attention.

She now sees as many as 12 patients each day in their homes across the Grand Traverse region. They are patients who sometimes don’t qualify for hospice care, but have significant medical conditions that make traveling to appointments difficult at best. The home visits also often catch symptoms of illnesses quickly and prevent costly trips to the emergency room as well, Hartl said.

“The response is huge,” Hartl said. “I don’t have enough staff.”

Her practice currently employs a full-time nurse and serves 94 patients, but Hartl expects she could keep at least three more nurse practitioners busy. Nurse practitioners are allowed to diagnose illness, devise treatment plans and prescribe medications.

David Murphy knows the value of Hartl’s mobile practice as good as anybody. Murphy is the caregiver for his mother, Adele, 91.

Adele suffers from several serious illnesses, including dementia. Her conditions make traveling to appointments a half-day affair and often leave her agitated and unsettled.

“Sometimes we just go in because she doesn’t feel well and she has so much wrong,” David said. “I would guess since we started with Julie that we would have been to the ER at least two or three times.”

Hartl headed off a hospital stay for Adele in September when she had pneumonia. David called Hartl at the first sign of symptoms. She quickly prescribed antibiotics and breathing treatments that kept the infection at bay, David said.

“Julie helped us pull her through,” he said. “I just don’t know what we would have done without her.”

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