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Doctor in the House

Also under the act, these programs would receive the majority of Medicare savings gained from prevented hospital visits. Such savings are measured by comparing the cost to Medicare of patients enrolled in visiting-doctors programs to the expected cost for similar individuals who aren't. In short, the major goals of the act are to decrease Medicare's costs, to provide incentives for talented professionals to enter the home-health care field, and to offer patients the best medical care possible.

Dr. Ana Blohm, one of the doctors at Mount Sinai, treats many patients in their mid-80s, most of whom have serious medical conditions. She said that she and her colleagues try "to prevent that catastrophic hospital visit that can occur at the end of someone's life." The people this happens to are the ones who get lost in the health-care system at times when they need it the most. According to Blohm, they "disappear for two or three years, in which they coast without medical care and then reappear into the system" after a 911 call. The service Mount Sinai provides is catching people in the window of time during which this can be prevented.

There is a lot of overlap in what visiting doctors can offer at home and in the office. Blohm, for example, recently treated two pneumonia patients in their own homes. If these patients had visited a doctor's office, they would have been admitted to the hospital, she adds. But this way, they are able to recover where they're comfortable.

Sometimes, Blohm says, visiting doctors can even offer better quality of care to patients at home. During home visits, she is able to focus on things that might not be apparent during an office visit, such as whether a patient is still smoking or isn't eating properly. She even notices simple things like whether a patient needs grab bars or whether their furniture needs to be rearranged to make it easier to get around.

"When we do a home visit, we notice a lot of things a patient may not admit to when they're in the doctor's office," Blohm related. "Red flags come up you can't see when they're in an office."

Physicians sometimes feel as if they aren't providing the care they should because of the pace of typical office visits, Blohm said. But home visits allow her to connect with patients on a more human level.

"When you see someone in their environment— surrounded by objects that reflect their personal history and trying to be a gracious host despite their physical or mental impediments—there is sort of a moment," Blohm said. "You can pause, stop, and appreciate the human being you're dealing with [as] opposed to the blood pressure, blood sugar, or whatever medical issues may be going on."

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