The doctor’s “house call” conjures up images of a black briefcase and a straight laced, neighborhood physician rapping his knuckles on a vintage front door. The scene is reminiscent of yesteryears and a bygone era, but one company new to Billings is bringing it back.
A new partnership between Billings Clinic and a company called Dispatch Health, an in-home medical provider, is opening doors to bring health care back into people’s homes.
The company aims to minimize unnecessary emergency room visits for those who are immobile or otherwise face a challenge when urgent care is needed but an ambulance is not.
The three person team, made up of two in the home and a third assistant joining virtually, are able to treat simple illnesses, minor injuries and carry out some procedures including blood draws and labs from within the patient’s home. A board certified and locally licensed emergency physician is also accessible for consultations, said Dispatch Health’s Chief Medical Officer Dr. Phil Mitchell.
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During surges of pandemic hospitalizations, emergency departments (ED) throughout the country were pushed to their limits. Staff did their best to treat acutely ill COVID patients alongside the regular rumble of emergent health issues, but the strain forced health systems to reconsider how and where care is delivered.
The transition to care in the home has already proved effective through telehealth models, and research into receiving acute and complex care in the home has been ongoing for decades. Studies beginning in 1995 at John Hopkins Medicine have found that administering hospital care in the personal and comfortable environment of one’s home resulted in better health outcomes, higher patient satisfaction and was more cost effective than going to the emergency department.
DispatchHealth vehicles are stocked with medical supplies as the Billings Clinic adds in home medical care service to Billings.
The model works particularly well for those with conditions that follow a defined treatment protocol such as respiratory infections, shortness of breath from chronic obstructive pulmonary disease (COPD), COVID-19 symptoms, flu, nosebleeds, urinary tract infections, strains, sprains, minor fractures and more.
The mobile unit can also carry out procedures such as advanced on-site blood testing, catheter insertion, stitches and set up an IV for fluids and medications, according to Karrie Austin, regional director of operations for Dispatch Health.
Visits from a Dispatch Health team are covered by most insurances and is billed similarly to an urgent care visit, Austin said. In EDs, doctors and nurses are prepared at all times for the worst possible outcomes, meaning patients take on all the costs associated with the necessary ED infrastructure.
Diverting patient care from the ED to more appropriate settings also frees up staff and EMS services to respond to true emergencies. Billings Clinic leadership announced plans in March to aim for a Trauma I designation, the highest designation possible for trauma centers in the U.S. Assessed by the American College of Surgeons, the Clinic will need to serve 1,200 patients a year with a major trauma.
The team, employed by Dispatch Health, has pledged to serve citizens within a 40-minute drive of Billings Clinic. Eventually, Mitchell hopes to expand into more rural communities, but to start, there will be one vehicle in operation until demand ramps up. By the end of 2022, there will be two vehicles with two to three teams available for house calls from 9 a.m. to 9 p.m. every day of the year.
While Dispatch Health can serve anyone from three months old to end of life, the majority of their cliental are 70 years old and older, Mitchell said.
“They just don’t have the resources that the younger patient population does,” Mitchell said, adding that the house calls give providers a chance to assess other social determinants of health such as access to food, transportation, housing and safe environments.
As the chair of Billings Clinic’s geriatrics department, Dr. Larry Severa has made many house calls for elderly patients. By meeting them where they’re at, or more specifically, from their Lazy Boy, Severa gets a glimpse into their lives that most doctors don’t see.
Since care moved into the sterile landscape of the exam room, Severa’s patients often view doctors and nurses mostly as people who pass out pills. Trust may be lacking and immobile patients may end up planning their whole day around the appointment.
“Health is so much more than that. It’s sitting with them, talking to them, holding their hand, listening to their hearts…there’s something about when they’re comfortable in their own home, it’s much more of a true picture of who they are and what matters to them,” Severa said.
Being in the home also allows Severa to identify potential hazards. A patient that uses a walker but has multiple rugs throughout their home has a higher risk of falling. When Severa talks through the dangers and can demonstrate how the patient can live more safely, many are more receptive to the information than if he were to give them a checklist in his office.
Severa plans to spread the word of the new service to nursing homes and assisted living facilities that he works with on a regular basis.
But Mitchell with Dispatch Health will do minimal advertising in order to make sure they tap the right clientele, those in need of urgent but non-life threatening care and those who face significant challenges in getting to a facility. This includes mothers with multiple children.
Upon requesting the service, patients will fill out an extensive questionnaire that will determine the severity of their condition and if they do, in fact, need to go to the ED.
Services will begin at 9 a.m. on Thursday, April 28, 2022. To request care, patients can call (406) 998-6299 or visit www.billingsclinic.com/dispatch. No referral is needed.
