Interventional Radiologist Meets Patients Where They Are
ER visits, readmissions decline with novel house call model
When interventional radiologist Nazar Golewale, MD, opened his own practice after almost eight years of working in a hospital system, he discovered a lot of undertreated and underserved patients who couldn’t reach the hospital. Many had numerous chronic conditions and were housebound.
For someone with pleural effusion or a feeding tube that needed to be changed or flushed, or a patient with cancer who needed a follow-up biopsy, a trip to the hospital or emergency room was required. This trip might involve an ambulance, or another transportation service not covered by insurance, that might not have available a needed wheelchair or stretcher. At the hospital, if no one was available to perform the procedure the patient would be admitted. If there was a shortage of available hospital beds, the challenges and costs further multiplied.
“There are so many patients who need services on a regular basis that can be done at home in a much more cost-effective way and where patients are at ease,” said Dr. Golewale, director at NG Vascular & Vein, who sees patients in their homes and at his office.
To meet the demand and see if at-home interventional radiology (IR) services were feasible, Dr. Golewale partnered with internists and podiatrists at Housecall Doctors PC. The company provides primary and specialty care in patients’ homes across a 30-mile area in Northwest Indiana.
Founded in 2010 by internist Saket B. Sinha, MD, Housecall Doctors was actively searching for an interventional radiologist to perform at-home procedures. IR procedures offered through Housecall Doctors include ultrasound-guided superficial needle biopsy, gastrostomy tube management, wound care, paracentesis, thoracentesis and ultrasound-guided joint injections.
"There are so many patients who need services on a regular basis that can be done at home in a much more cost effective way and where patients are at ease.”
NAZAR GOLEWALE, MD
Providing Convenient Care at Home
To see how effective their overall services were, Dr. Golewale and his colleagues tracked their at-home procedures from August 2018 to August 2019.
For all procedures, which included many non-IR procedures, the group completed more than 951 clinical visits to post-hospitalized and homebound older adults. They provided routine and preventive care and served patients with acute and chronic conditions.
ER visits for patients served by the multidisciplinary house call team declined by 77%, according to research presented by Dr. Golewale at the 2020 Society of Interventional Radiology (SIR) Annual Scientific Meeting. Hospital readmissions were cut in half. In follow-up surveys, patient satisfaction increased from 17% to 84% following house call appointments and health care costs were estimated to be reduced for patients and payors.
Most importantly, patients’ understanding of their treatment plans increased, Dr. Golewale said. At-home providers were able to spend more time with patients to discuss important follow-up information, including answering questions about medications. Patients also appreciated when a house call physician could see them sooner than the typical two- to three-month wait for many specialists.
House Calls on the Rise
Dr. Golewale’s patient volume has doubled since the study and he expects specialty care at home to expand as more data is published and other professionals embrace it.
“There was a lot of skepticism in the beginning that IR procedures couldn’t be done at home or that it’s not appropriate for these patients, conditions or situations,” Dr. Golewale said. “I hope that by demonstrating in this small study the benefits of at-home IR procedures, more physicians will want to collaborate on ways they can bring their treatments or procedures directly to the patients.”
It’s important, Dr. Golewale added, to realize that there are effective delivery models beyond the hospital.
“Physicians can identify unique ways to serve the community and those patients who are better or more easily served outside of the hospital,” Dr. Golewale said.
For More Information
Access the abstract, “A novel health care delivery model – house call docs,” at jvir.org.
Read the RSNA News stories on interventional radiology: