Hometown Health blends telemedicine with house calls

Patient Paul Coward speaks with Hometown Health Centers' Chief Medical Officer Dr. Cristine Espinosa on a computer held by home health coordinator Shirley DeLuca at his home in Schenectady on Monday. Photo by Erica Miller/Staff Photographer

SCHENECTADY — House calls and telemedicine, merged by necessity during the height of the COVID crisis, have shown strong results and remain one of the tools Hometown Health Centers relies on to treat high-needs patients.

The concept is straighforward: A nurse and medical assistant take a computer to the home of a patient who doesn’t have a computer or can’t work a smartphone app and can’t come to the clinic. The patient consults with a doctor virtually, the doctor inspects the patient via webcam if necessary, and the doctor prescribes steps or medications to address the problem.

But the house calls have yielded something as important as treatment — they have given medical providers a look into the lives of their patients, and a glimpse of what may be causing or contributing to their medical problems.

“We’re able to screen a little more efficiently for social determinants of health,” said Laurie Levasseur, practice administrator for Schenectady-based Hometown Health. These could include unsanitary or unsafe conditions, poor or insufficient food choices, and medications prescribed by multiple doctors that might be harmful or ineffective in combination with each other.

This last situation is a leading cause of emergency room visits, Levasseur said, and it’s something that not all patients can be expected to prevent themselves, especially those who are forgetful or are not knowledgeable.

The Hometown Health providers have repeatedly come across unsafe combinations as they perform what is called medication reconciliation, the inventory of a patient’s meds.

“This has proven to be an eye opener,” she said. “I believe that we saved potentially many ER visits just with that.”

When the area’s COVID infection rate was higher, Hometown’s Telehealth Home Visit Program sent caregivers to homes in gowns, booties, gloves and masks to care for those who were sick or who were healthy but couldn’t risk a visit to the clinic — and also couldn’t handle the technology involved in telemedicine.

Most of the patients seen in their homes have been Schenectady residents, a few have been Albany and Troy residents. The program hasn’t rolled out in Amsterdam yet.

Paul Coward of Schenectady is a longtime patient at Hometown, along with the rest of his family. He became a Telehealth Home Visit patient after sustaining a broken wrist and serious burns in an accident earlier this year.

Most patients in the program are in a high-risk category, but some are simply incapable of travel. Coward was in this latter group.

“I was bed-bound for about two months,” he recalled. “They were very helpful. The first couple of weeks, they came twice a week.”

The doctor would assess his burns via webcam and the nurse would change his dressings.

“That was difficult for me, I was one-handed,” Coward said.

“It was not as good as being there” at the clinic, he added, but said the clinic was not an option early on.

He’s nearing a full recovery now.

Hometown Health CEO Joe Gambino said the program has been a case of something old being new again.

“Home visits used to be part of the standard operating procedure of your community doctor,” he said. “It was something that was really born again through this pandemic.”

As good as the results and reception have been, the economics are not great. Hometown has to cover the cost of sending two people out into the community with electronic gear. Reimbursement paid to Hometown is the same as for a regular office visit, even though the house call takes significantly longer.

The one positive note on cost is that the state of New York has allowed reimbursement at the rate of a normal clinical visit rather than at the rate for a telemedicine visit, which is substantially less than an in-person visit, Gambino said.

“What I’d like to think will happen: We’ll promote the success of this program and the many benefits that come along with it,” he said, and insurers will increase reimbursement as a cost-saving measure. If they see they’re spending less on Telehealth Home Visit than they would be on emergency room visits, the equation might work for them.

“I’d love to continue it,” he added.

Gambino mentioned the same benefit Levasseur pointed out: Being able to assess the social determinants of health, the factors in a person’s life that tend to make them more or less likely to need medical care.

While medical professionals can’t resolve some of these issues for patients, they can put patients in touch with the right people to help.

“We’re connected to so many nonprofits in this community that we can connect them to some of the organizations,” Gambino said.

Levasseur said Hometown Health has provided in-home telemedicine care to more than 300 people so far this year, many of them high-needs patients that Hometown’s case management department determined might be at risk of falling through the cracks during the COVID crisis.