- The Washington Times - Monday, August 22, 2005

Medicare sees

cost benefits

When Isaac Young, a retired cabinetmaker in Los Angeles, got sick with breathing problems three years ago, it wasn’t easy for his wife, Theresa, to get him into a doctor’s office.

So when Mrs. Young, who is now 74, heard about a new program that would have the doctor come to their home in emergencies as well as for routine visits, she signed up.

“It’s been a blessing. I just couldn’t handle those visits for my husband to the doctor,” said Mrs. Young, a retired beautician. “We seemed to be running to the doctor all the time. Now Dr. Martinez comes right away when I call him.”

Dr. Gerard Martinez, 37, practices what he calls “old-fashioned medicine” that has him going to the patient’s home, rather than having the patient come to his office.

Medicare is about to begin a test of the home-visit program in California, Texas and Florida to determine whether it can be adopted nationally and cut spending by the federal health insurance system. In California, the test will start this fall in San Francisco, Los Angeles and San Diego.

“We view home visits as a very promising concept,” said Jeff Flick, Medicare’s regional administrator. “We’ll know in three years if it provides quality care for patients and can work nationally to reduce Medicare costs.”

Dr. Martinez, who has been visiting patients at their homes in Los Angeles for more than two years, acknowledged that many doctors are skeptical that home visits are good for them or their patients.

In offices, doctors have the assistance of nurses and technicians. They have laboratories, receptionists and bookkeepers handling the complicated billing required by insurance companies and government agencies.

But Dr. Martinez said that today’s medical practice, with a huge overhead, often forces doctors to see a patient every 15 minutes, with little time to listen or offer advice. These doctors may have a list of more than 1,200 patients, he said.

“I have about 120 patients, and on a typical day I see seven to 10 of them in visits that never seem hurried,” said Dr. Martinez, who works for Care Level Management of Calabasas, Calif.

He is driven on his daily rounds by an assistant responsible for scheduling. Dr. Martinez said he uses car time to talk to patients via cellular phone and check their records electronically.

Mark McClellan, the federal Medicare administrator, said that the three-year test in California, Florida and Texas will show whether patients get the “best possible prevention-oriented care.”

Raouf Khalil, Care Level’s chief operating officer, said the patients in the test fit into the 3.5 percent of Medicare beneficiaries who run up 43 percent of Medicare’s annual spending, mainly on emergency room visits and hospitalization.

Mr. Khalil said that he expects the study to show that home visits by doctors can cut emergency admissions by 60 percent and hospital costs by 30 percent.

The plan appeals to doctors who want to spend more time with fewer patients, Mr. Khalil said. The base salary for these doctors starts at $165,000 a year.

• Distributed by Scripps Howard

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