Whether the need is for post-hospitalization follow-up, diabetic foot care or simply a routine check-up and flu shot for the disabled patient, help is on the way. Literally.

Thanks in part to a provision called Independence at Home, part of the recently passed and continuously contentious Patient Protection and Affordable Care Act, more physicians are making house calls. That's right, house calls.

Merrillville physician S.B. Sinha, M.D., visits patients to take their blood pressure, check on medication dosages/interactions and perform a battery of tests and procedures right in their home.

While Dr. Sinha's in-home medical practice is a recent addition to Northwest Indiana, the number of physicians like him is increasing. A Chicago-based firm called Mobile Doctors also has physicians, podiatrists and medical technicians who provide in-home health care services to patients in Northwest Indiana. And a quick search on the American Academy of Home Care Physicians' website (AAHCP.org) yields the names of other medical providers serving most states including Indiana, Michigan and Illinois.

It is estimated there are approximately 4,000 physicians, nurse practitioners and other medical professionals nationwide who either specialize in in-home care or at least make it a part of their practice.

Is this special artisanal health care reserved only for the wealthy? Definitely not.

According to Dana Robinson, Vice President of Marketing for Mobile Doctors, the vast majority of their patients are seniors on Medicare, and many are low-income Medicaid patients. Dr. Sinha also says that the bulk of his patients are on Medicare.

Both Dr. Sinha and Mobile Doctors accept private insurance as well. However, many private insurance companies require prior approval. In addition, Dr. Sinha notes that he cares for several patients who have no medical insurance at all. "When I took the Hippocratic Oath I meant it. I am not in this to become wealthy," he says.

Even so, according to both Ms. Robinson and Dr. Sinha, the cost is not prohibitive but is comparable to the cost of a visit to a physician's office. And as the AAHCP notes, "house calls are more likely to prevent unnecessary and far more costly [emergency room] visits and hospitalizations. At $1,500 per ER visit, the cost of 10 house calls is offset by one ER visit prevented."

This is something that Dr. Sinha is particularly proud of. "I can check up on patients to make sure they are taking the correct dosage of their medications, observe the challenges they encounter in their homes and work with family members to assure the best quality of care."

If a patient requires supportive short-term services such as wound debridement, catheter care, physical or occupational therapy, etc., the Indiana University Health LaPorte Hospital Visiting Nurses Association also makes house calls.

Again, private insurance, as well as Medicare and Medicaid cover the costs for many of these services. However, they are limited to short term and/or intermittent needs.

The scope of their services ranges from nursing care to bathing and even house cleaning, according to Director Suzanne Manthey.

AAHCP Executive Director Constance F. Row notes that although the number of physicians offering home-based services is growing, demand is outpacing supply.

"While 4,000 medical professionals are currently making home visits, the need is for more like 10,000," she says, because of the millions who are suffering with multiple chronic conditions.

It is a number that is expected to escalate so, in order to attract more physicians, the AAHCP advocates physician education in primary home care as well as adequate reimbursement.

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