Physician assistant revives house call tradition in Berkshires
PITTSFIELD -- Jeff Kellogg is racking up odometer miles on his two Hondas since starting Berkshire Mobile Medicine late last year.
A physician assistant, he joined with Dr. Charles D'Agostino to resuscitate the making of house calls. Years ago, doctors routinely visited patients at their homes, but in recent decades, for financial reasons, that practice has become rare.
With about 200 patients, Kellogg said it's evident that there's strong demand.
Pittsfield resident David Brown is among those who see value in the "house call." He said it's almost "impossible" for him to get to the doctor's office because he has a progressed form of lymphedema -- localized fluid retention and tissue swelling -- which causes his legs to swell and go numb.
With numb feet, he had to stop driving because at one point he stopped feeling the pedals. Even walking from the parking lot to the doctor's office was a challenge.
He called other doctors to make home visits, but they turned him down and he stopped going for treatment.
After a recent mild heart attack, he was again challenged to get the treatment he needed and was referred to Kellogg.
Rick Gulla, a spokesman for the Massachusetts Medical Institute, said he hasn't heard of many doctors making house calls, but doctors are aware of a possible future demand with an aging senior population.
In Northampton, physician Jill Griffin has taken to riding a bicycle in a new venture called PedalMed offering "health coaching" house calls to people with chronic diseases and other health issues after 17 years working in hospital emergency rooms.
Kellogg's patient Brown is appreciative.
"He's the first doctor ever not to say, ‘Your appointment is over and I've got to go,' " Brown said.
Kellogg is the majority owner of Berkshire Mobile Medical and makes all home visits. D'Agostino is a minority partner.
D'Agostino owns and runs Pittsfield-based Mountain Medicine on East Street, but Kellogg said Berkshire Mobile Medicine is not an auxiliary of the medical firm.
Kellogg said state law requires physician assistants or registered nurses to team with a doctor to provide medical care. He said a physician assistant has two fewer semesters of training than a doctor and is not required to fulfill a residency.
He was moved to set up a mobile practice after seeing his grandmother challenged to get medical care.
"Seeing her struggle was definitely a realization to me that the need was huge," Kellogg said.
He said home visits became economically feasible for medical professionals like himself after studies by the U.S. Veteran's Administration led Medicare three years ago to slightly increase the reimbursements for house calls. He also does not have to carry the cost of a secretary or office.
With eight to 12 patients a day, he is optimistic about the long-term viability of his business.
His patients are predominately on Medicare. In the coming months, he said he hoped to become covered also by New England Health and GIC.
"They typically have pretty major medical issues," he said.
The house visits have been revealing. Kellogg said that one patient had respiratory problems and he was able to identify the cause as second-hand smoke.
"When you're sitting in the living room and kitchen room table, it's easier to get to know them," he said.
Kellogg diagnosed a kidney problem for his patient David Brown and arranged for home help from a visiting nurse association.
"I should have been on it for some time," Brown said about the medication for his kidney problem.
To qualify for a house call visit from Berkshire Mobile Medicine, patients must either need a device to walk, be unable to drive, have either a visual impairment or memory disorder, be bedridden, be restricted to limited activity following recent surgery, or unable leave home with out a "considerable or taxing effort."
Even without the amenities of an office, Kellogg is satisfied with his work.
"I feel like I've found my niche," he said. "It fits. It's what I enjoy doing. It's where I belong."
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