High Tech Home Care in Perspective

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High Tech Home Care in Perspective

• C. Gresham Bayne MD
• President, AAHCP

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Emergency Rooms, 2006

• 110M visits
• 85 do not need immediate MD attention
• 67 of elderly arrive by ambulance
• 80 admission rate of the over-75 yo
• Gridlock systems, especially during flu
• Has become primary care access for the frail
  elderly and disabled

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Mildred, Pulseless in the Pew

• 94 yo woman suddenly sick in Church
• Unable to speak
• No radial pulse
• 911 is obvious with 8.6min avg. response

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911 response

• 90 of Code 1 transports not life-threatening
• Cost over 1,200
• Protocol-driven
• Government contracts controlling
• Nearest hospital rules

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On arrival in the ER

• Vital signs
• Oxgyen
• EKG monitoring
• oximetry

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ER testing on cardiac patients

• EKG
• ABGs
• Electrolytes
• Glucose
• BUN
• Hemoglobin
• Troponin, etc

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Rarely available in the ER

• Cardiac impedance
• Adequate history
• Helpful citizens to support social net
• Transportation home for guerney

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You ask why I did not send Mildred to the ER?

• With modern housecall technologies, today THE
  DOCTOR is the ER!

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Cost comparison

• Home visit,established patient, with all labs,
  EKG and oximetry as well as cardiac impedance
  testing
• Under 300

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Cost Comparison, 2

• Emergency Room Visit for the same treatment
  without cardiac impedance
• 3,000
• Plus hospital admission most likely

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Lesson for Policy-Makers

• By giving the patient what they wanted in the
  first place, huge savings are waiting to be
  designed into the new Medicare payment
  structures.
• C. Gresham Bayne MD

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