House Calls


Dr. Brian Stephens went into residency at the Mayo Clinic in Jacksonville after graduating from the Medical College of Georgia in 2002. He loved seeing patients, but he didn’t love the short bit of time he was expected to spend with each one.

“I was always pushed to see more patients, to get our clinic down to ten minutes per appointment,” he says. “Patients hated it. I hated it. I couldn’t fathom spending the rest of my career like that.”

After completing his residency, he stumbled into house call medicine. He dabbled in it for a while. Then Stephens and his wife, Dr. Tea Kuharic Stephens, decided to start Little Black Bag Medical. Their practice focuses solely on house (or office, or wherever the patient is) calls, and they have somewhere between 200 and 300 patients in the Jacksonville area.

Today’s house call medicine is the millennial version of what your grandparents’ doctors practiced. Just like the physicians of yesteryear, they visit patients’ homes, spend time with them, check them, and make necessary recommendations—but with 21st-century technology like the Internet and mobile machines that can assist in almost anything the patient needs, including ultrasounds, IVs, biopsies, EKGs, X-rays and much more.

Concierge medicine is making a come-back after all but disappearing around the 1980s. Medicare billing changes in 1998 made it easier for physicians to get paid for home visits. Since that time, the number of physician house calls to Medicare patients has grown; in 2000, around 478,000 house calls were made. In 2006, that number had more than doubled to over 995,000.

“It’s definitely growing, there’s no doubt,” says Stephens. “I can’t fathom that it wouldn’t continue to grow in the next few years, especially with the aging population.”

The elderly are not the only ones who benefit from Stephens’ service. “I do have quite a few patients that are younger and healthier but are very busy. Professional types that don’t have time to wait in a doctor’s office,” he says. “I’ve also got a couple families with smaller children—mom and dad don’t want to have to take half a day off work to take kids to the doctor.”

All these people, whether sick, elderly or busy, have one thing in common: a close relationship with Stephens. And with that comes an understanding that a simple office visit could not provide.

“Our practice is set up so that we have a personal relationship with our patients. When they call, they get me. We know them, they know us,” he says. “I know their family members, I know their dog. When you’re in someone's home, it’s hard not to develop that relationship.”

“It allows me to see issues or problems that might lead to a medical problem. I once had a patient who had a persistent rash that was causing a lot of issues and discomfort. By going into the home, I could see that their pets had fleas,” Stephens continues. “Because I’m there in the house, I can find things in their environment that a normal physician in the office can’t pick up on.”

Patients’ homes provide a wealth of information, from what they’re eating to where they sleep. Stephens checks medicine cabinets, refrigerators, pantries and bedrooms looking for issues that might be causing a problem—or could cause one in the future.

“You can actually save money on ER visits,” he says. “It’s a way of taking a step back; to be much more personalized and focused on patients’ needs. It saves the system a lot of money.”

It’s true: according to a 2009 Washington Post article, homebound patients (a large part of house call doctors’ clientele) represent only 5% of the Medicare population, but they consume more than 43% of the budget. A 2012 article in Generations, the journal of the American Society on Aging, reports that Inspiris, a company that provides house calls to Medicare patients, found that hospital admissions, re-admissions, emergency room visits, prescription medications per patient and total costs were all reduced after the introduction of their services, while patient satisfaction increased.

In that way, Stephens’ house calls—which he admits are “probably a little more expensive” than office visits—save money in the long run for hospitals and Medicare as well as his patients. But that’s not why he does it.

“We enjoy it and our patients tend to enjoy it,” says Stephens. “I spend my whole day outside, driving around in the nice weather. I think I’d go insane if I had to go back to the typical office now.”