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News Roundup: September 4, 2015

New technology helping seniors stay in their homes

Published by Rapid City Journal
Christy Hammond
September 4, 2015

Most seniors prefer to remain in their homes as they age, but because of declining health that isn't always possible.

“Statistics have shown that a senior uses home health care for around nine months, but averages 21 to 24 months in a senior living situation,” said Lezlie Snoozy-Kaitfors, owner of Comfort Keepers of the Black Hills.

The Rapid City business, which provides in-home care services, is helping seniors stay in their homes thanks to advances in technology. Each senior's case is different, so an assessment of their needs must first be conducted, Snoozy-Kaitfors said. “We look for a complete solution to this person’s care,” she said.

The grandCare system monitors seniors while they're at home, alerting Comfort Keeper's home health team if there are irregularities like activity during unusual times. A touchscreen monitor that comes with the system allows seniors to easily access news, weather, or Skype with family members.

“The grandCare system can also be set up with reminders for such things as medications,” Snoozy-Kaitfors said. “It also takes and records weight, blood pressure, pulse oximeter and glucometer. If numbers are out of range, it notifies us, so we can contact the senior and figure out what’s going on.”

Other equipment can be set up in seniors' homes such as locked medication dispensers that are programmed to dispense the correct amount of medication at the proper time.

“The medicine regimen of a senior can be complex with multiple medicines needed at certain times. A dispenser can eliminate the risk of medicine error. It helps to prevent overdoses,” Snoozy-Kaitfors said. “Non-compliance of medication is one of the big reasons why someone ends up in a facility.”

Other technology includes wearable pendants, which seniors can use to call for help if they need assistance.

Even with the advances in technology, Snoozy-Kaitfors finds that there is a stigma surrounding the acceptance of home health and seniors wanting to enlist their services. But she says employing home health services is a proactive measure, allowing caregivers to set up a system that allows loved ones to maintain independence for as long as possible.

“We’re fortunate in this time period where we are with the aging population and where the technology is,” Snoozy-Kaitfors said. ““These advancements can lead to longer independence and a sense of safety in place.”

The doctor's in the house

Published by The Casswell Messenger
September 4, 2015

Each day, Rhonda Lucas, a Certified Nurse Practitioner, loads her medicine bag in her car and drives to see patients at their homes in Alamance, Caswell or Rockingham Counties. Part of the Caswell Family Medical Center’s House Calls program, Lucas said it is a job that she truly enjoys.

“I love that personal touch of sitting down with someone instead of just seeing them in an exam room. People don’t always like to come to the doctor’s, but people usually like to see me.”

There are currently about 180 patients who are signed up for the House Calls program. “My average is 6 patients a day,” said Lucas. “I see patients in assisted living and group homes and in their own homes. This program works great for everybody. Our policy is that we will see people if it is a taxing effort to get to the doctor either physically or mentally.”

Lucas, who was a home hospice nurse for 35 years, said she was accustomed to caring for patients in their own homes. In fact, when Lucas became a nurse manager with the hospice program she found she missed working with the patients. “I missed nursing and I wanted to go back to the bedside role but I didn’t want to be a nurse again,” remembered Lucas, who then made a big choice. “I went back to nurse practitioner school when I was 50. It wasn’t easy because I was old enough to be the other students’ mom.”

She said she is very fortunate that, when she decided to go back to school, her family supported her. “We did without some things back then but it was worth it,” said Lucas. “I love what I do. I am back at the bedside but in an expanded role.”

She obtained her Master of Health Science-Nurse Practitioner from UNC-Greensboro. She is also certified by the National Association of Nurse Practitioners. Lucas can now see patients, diagnose them and write prescriptions.

“I have some patients I have to see every week and I have others I see once every three or four months. I have four or five patients in hospice at any given time,” said Lucas. “I am now their primary care provider.”

Lucas, who sees patients from Stoneville to Mebane and north all the way up to the Virginia line, said she tries to separate her days by geographic area. “The people that I see have a difficult time getting out to the doctor or a difficult time sitting in the waiting room for either physical or mental reasons. I try to keep people well and keep them in their homes.”

Referrals for the program come to Lucas from home health and hospice agencies, insurance companies, other providers at the clinic or calls from families or the patient themselves. “Sometimes a patient has a hard time because of a walker or wheelchair. I have people that are completely bed bound. In order for them to get somewhere it is by stretcher and their only choice is to have to pay for an ambulance to get to the doctors.”

Lucas added that her services do not cost any more than a regular office visit. “It is the same copay. We bill Medicare or Medicaid or private insurance. Even if they don’t have insurance we do a sliding scale.”

In addition, if a patient improves and wants to return to office visits, Lucas said it is no problem. “They can change their mind at any time,” she said. “Our main thing is that they stay as well as possible.”

Last September, the center received a Federal grant for Improving Access to Healthcare which allowed Lucas to hire a very valuable assistant. “We hired Amy Cobb who is not only a nurse but also a case manager,” said Lucas. “Her background is with hospice and the Brian Center so she is great with the patients.”

“Her role is intake; a lot of it is answering calls from patients or from home health agencies regarding my patients. She takes my calls for any needs they have. She helps me be more productive.”

Lucas said that Cobb has even helped patients who called about broken wheelchairs or other equipment needs. Lucas added that if anyone would like to become a house calls patient, they should call Cobb who will help them register.

With the current shortage of doctors nationwide, Lucas said that nurse practitioners are filling that gap. “Nurse practitioners are in a position that we can really help provide a healthy environment. We can reach out to people who don’t want to go to a doctor and we can help be the provider that person needs in this shortage. With the new healthcare laws, people need to have a primary provider so this is perfect.”

Lucas said she feels it is important that she stays up to date on new procedures and other information so she is sure to keep learning. In September she plans to attend the Gerontological Advanced Practice Nurses Association National Conference in San Antonio. “I will be getting a lot of information there on taking care of geriatric patients. I am also an officer in the chapter in Greensboro Gerontological Advanced Practice Nurse Associations. It is created to keep us informed and in touch with each other.” In February she will return to John Hopkins for geriatric update. “We stay up to date and I share that with my colleagues here,” said Lucas.

In addition, Lucas added, the providers at Caswell Family Health Center network with each other, bringing things they have learned back to the team. “They go to other conferences and share their information,” she added. “We all have our own focus so we go to each other with any questions. We work very well together here. We recognize each other’s strengths and we build on that.”

Lucas said that she doesn’t think she would be as happy doing anything else at this point in her life. “It’s a great program and I really enjoy it. I am like a nurse, a social worker, and a provider all wrapped up into one. I guess my favorite part is sitting at someone’s kitchen table and finding out what is really going on. My visits are longer so I have close relationships and I really love that.”

Bringing back the house call: Apps in some big cities let you summon a doctor

Published by The Kansas City Star
Greg Hack
September 4, 2015

If you’re old enough, childhood memories include being able to get your family doctor to come to your house — even if pizza delivery didn’t exist yet in your town.

Now, thanks to a new batch of smartphone apps, people under the weather in and around Los Angeles, San Francisco and New York can summon a doctor, sometimes faster than they can get a double pepperoni with extra cheese.

Pager started in New York and has expanded to San Francisco. Its app lets users request a house call and see available physicians.
Pager started in New York and has expanded to San Francisco. Its app lets users request a house call and see available physicians. Pager
Similar to Uber’s ability to send for a ride, the apps Heal, Pager and FirstLine Medical let prospective patients, in return for a credit card number and some information on their medical issue, order a house call. The physicians come prepared for any minor ailments, much like those treated at urgent care clinics, but they also can handle some ER chores such as stitching up nasty cuts and, given the increased portability of today’s technology, perform sophisticated testing.

The services favor flat fees, paid up front — Heal charges $99 for a visit, Pager $50 for a first visit and $200 after, FirstLine $199 for most basic calls. They don’t take insurance, though some are working on adding that, but they do provide records that can be filed with an insurer and shared with a patient’s family doctor, if there is one.

Those services launched this year or last and have attracted millions in startup capital and made thousands of house calls. And as they add cities, they could eventually make their way to Kansas City and other midsize metro areas.

Heal got started in Los Angeles and nearby Orange County early this year after a particularly long and frustrating night at a hospital.

Renee Dua’s son was sick, and she was advised to take him to an emergency room. She’s a doctor, a kidney specialist, but says, “I don’t practice medicine on my son.” So she took her little boy to the hospital and waited. And waited. Eight hours later, the diagnosis came: just a bad cold.

“I told my husband, ‘There’s got to be a better way to do this,’” Dua said in a recent interview. “We’re lucky. But what about people who can’t afford to leave their jobs for hours?”

Her husband, Nick Desai, a serial entrepreneur, knew how to assemble investors, and Dua recruited fellow physicians interested in mixing some unhurried, one-on-one care into their practices.

“The idea behind Heal is twofold: to provide access to high-quality, convenient, affordable health care,” she said, “and to give physicians a better, more personal way to provide some of that care.”

A second round of venture capital has come in — backers include singer Lionel Richie, Qualcomm executive Paul Jacobs and former Los Angeles Dodgers co-ower Jamie McCourt — and Heal expanded to San Francisco in April. Dua and Desai would like to add 15 more cities, though Dua isn’t saying which those might be.

The house call apps are a logical extension of the already extensive use of telemedicine, for rural and homebound populations and also by similar new apps and services. Doctor on Demand, based in San Francisco, is supported by Google and Phil McGraw, TV’s “Dr. Phil.” It followed Teladoc and MDLIve into telemedicine.

And in one niche, the Spruce app lets patients get dermatology advice and treatment after sending in a photo and description of a skin problem.

But they don’t offer home visits, as Heal, Pager and FirstLine Medical do.

Pager, which started in New York and recently made the jump to San Francisco, starts with an online “visit” to determine whether a house call is needed, and what equipment the doctor should bring in that case. Ailments treated without an in-person visit are just $25.

And when members of the Pager team say they want to be the Uber for doctors, they know what they’re talking about. One founder, Oscar Salazar, was also on Uber’s initial team, and he helped start Pager when two other entrepreneurs brought him the idea.

Andrew Chomer, Pager’s head of marketing, said, “We’re interested in providing the right type of care for individuals. Pager provides the personal touch when needed but adds the layer of efficiency telemedicine can bring in many cases.”

Chomer said since Pager’s late-November launch, its 20 physicians had made thousands of house calls in New York, and now five doctors are on board in San Francisco.

San Francisco is where FirstLine Medical launched, and CEO Bryan O’Connell says the service has seven physicians in its group and is adding 10 more to meet rapidly growing demand.

FirstLine is already gearing up to operate in Boston and sizing up Phoenix as a possible third location, said O’Connell, so Midwestern metro areas such as Kansas City also could be house call app markets eventually.

“The need for good health care at transparent prices is universal, so I don’t think our services have to be exclusively in big cities,” said O’Connell, a venture capitalist from Ireland with experience on the business side of the United Kingdom’s National Health Service.

House calls and their benefits, of course, are nothing new. But they went from 40 percent of doctor visits in 1930 to 10 percent in 1950 and, with the rise of specialized medicine, just 1 percent in 1980. Now, the increase in technology, along with some changes in Medicare reimbursement and Affordable Care Act efforts to reduce costs, are helping them come back.

One company in the vanguard of house call apps was Medicast, started in 2013 by brothers Sam and Nafis Zebarjadi. They spent time in Kansas City at Sprint’s Mobile Health Accelerator developing their company and now have offices in Mountain View, Calif.

But Medicast gave up on its direct-to-consumer model, which operated in California and Florida, in part because consumers had trouble trusting a new-name startup. Instead, Medicast is partnering with large hospital networks interested in its software and services, starting with a house call app for Providence Health & Services in the Seattle area.

Such a partnership would be another way on-demand house calls might come to the Kansas City area. Cerner Corp. and other big health-care players in the area — St. Luke’s Health System, University of Kansas Hospital, North Kansas City Hospital, HCA — say they don’t have house call app plans in the works, but they’re the type of partner Medicast is courting.

Other related home-care services have sprung up, too. In the Denver area, “house call ambulances” are equipped to provide acute care when they arrive at someone’s home, often saving a much more expensive trip back to an emergency room and a hospital stay.

And in Chicago, Go2Nurse Inc. co-founder Meg Kubiak, a registered nurse, had the idea of an app to summon nurses, because “from time immemorial, the majority of health care has come from nurses,” said Ed Ben-Alec, who created the software for

But the company soon realized it would be better to use its technology and nurse network to provide regular care for chronic conditions and follow-up care for surgery or trauma patients.

That keeps business and nurses’ workloads more regular and takes advantage of changes in Medicare reimbursement to help with home care. Patients, whose lack of mobility often makes a trip to the doctor an ordeal, get regular care at home. And whoever’s paying the bill — government program, private insurer, patient, or a combination — can pay a little more for home care but possibly a lot less in the long run by avoiding emergency-room trips, or complications and relapses that require another hospital stay.

The Kansas City area was almost Go2Nurse’s second location, Ben-Alec said. But severe cutbacks a few months ago at the Kansas Bioscience Authority, which was considering helping finance a Go2Nurse operation in Johnson County, scuttled that possibility.

“We were literally driving along the Mississippi River, set to head west across Missouri,” Ben-Alec said, “when we got the phone call” canceling a meeting with authority officials.

But if the economics of more widespread house calls work out elsewhere — whether by startup app, hospital network outreach or efficiently managed quick response — they could spread across the country eventually.

As Dua, the doctor behind Heal, put it, “We provide convenient, high-quality, personal care in the privacy of your home.” If you’re a Heal patient, she said, her staff members go the extra mile. For a small extra fee, they’ll even deliver prescriptions.

But for that double pepperoni, you’re on your own.