DOCTORS ON WHEELS MEDICARE HOUSE CALLS PROGRAM CUTS COSTS, DECREASE ER VISITS.

Byline: Diana McKeon Charkalis Lifestyle Editor

It's checkup time for Yetta Braverman, and this doctor's visit is happening right in her living room. Physician Tamika Henry sits beside her on the sofa, checking her vital signs and questioning her about medications, nighttime breathing problems and the swelling in her legs. But they also chat about other things - like marriage and family.

There are ``oohs'' and ``aahs'' when Henry breaks out photos from her recent wedding. Braverman, 85, shares stories about growing up in New York City and offers the doctor a discount coupon for Bed, Bath & Beyond. ``She keeps me laughing,'' says Henry, smiling.

There's a comfortable feeling between the two women as Braverman recounts how, during her childhood, the family doctor made house calls for $2 a visit. These days, the Sherman Oaks resident is once again getting this personal service. But this time, it's free - part of a new three-year Medicare pilot project for chronically ill senior citizens that offers round-the-clock access to in-home physician care.

``We're going back to the way physicians used to practice in the past, when they had more time to spend with patients,'' says Dr. Henri Becker, co-founder and chief medical officer of the Calabasas-based Care Level Management. The company was awarded the contract to provide on- call physicians to 15,000 seniors in California, Texas and Florida, about 4,000 of whom are living in Los Angeles County.

One major goal of the project is to avoid costly trips to emergency rooms for these patients, a common problem. According to the Centers for Medicare and Medicaid Services, chronically ill elderly make up only 3 percent to 5 percent of beneficiaries, but they use 43 percent of total Medicare costs, primarily through hospitalization.

``A lot of it is preventive care,'' Becker says. ``I tell patients - when you don't feel well, don't wait - call us. For them, it's a solution to their problems. When you get sick after 5 p.m., you can't always reach your primary-care physician.''

During these visits, the physicians use the full scope of their medical expertise and training to try to maintain each patient's health.

``These are patients with chronic conditions that need to be managed very aggressively in the home setting,'' Becker says. ``We're focused on some of the most fragile patients with the most serious illnesses.''

The doctors come equipped with tools of the trade, such as a stethoscope, otoscope and a fingertip device for checking oxygen levels in the blood. They can prescribe medication if the patient needs it before they will be able to see their primary-care physician. However, for more complicated tests or medical procedures such as suturing, for example, they may direct a patient to a hospital or clinic. ``If they need to go to the hospital, of course, we do send them,'' Henry explains.

Beginning Oct. 3, prequalified seniors who met the criteria, which include the presence of at least one chronic illness, were contacted by Medicare about volunteering for the program. Those who did were given the cell-phone number for a physician who would be available to them 24 hours a day and who also would check in on them regularly during scheduled home visits. Unlike many primary-care physicians who see between 20 and 40 patients each day, these doctors have six to eight, allowing them to spend more time with each person and develop a rapport.

``They're not replacing the primary-care physician, they're supplementing them. It's a win-win situation,'' Becker says. ``We feel it's a model that's going to change the way we practice care for these patients.''

For Henry, a typical day starts around 9 a.m., when she hops into her charcoal-gray Acura and heads off to see her first patient. About eight hours and fewer than 10 patients later, her shift is done.

She may spend 30 minutes with an established patient and up to 90 minutes with a new one. ``You're just trying to get information and develop a rapport,'' she says. ``It's the trust that's key.''

Although the practice of house calls may seem quaint, she comes equipped with a very modern doctor's bag that's gone high-tech - featuring a global positioning system to get her where she needs to go and a wireless handheld PDA that gives her real-time access to patients' records.

Although she appreciates the gadgets, it's the chance to develop strong bonds with her patients that she values most.

``You don't have any issues regarding time, and you don't have to wear a white coat,'' says Henry, who on this day sports a red jacket. ``You really get a chance to do what you got into medicine for - to treat people. A lot of times, when you work in an office you get caught up in other things. This is one-to-one.''

Henry says seeing patients in the home makes them more relaxed and also allows her to make sure they're taking their medications. She can also look for subtle signs of illness that can be nipped in the bud with intervention.

``We find if you follow someone closely, if something is a little off, we'll notice it. I'll know when I walk in the room if something's wrong.''

Earlier this year, Braverman had a sinus infection that got worse on a Friday night. Her primary-care physician was out of town, so she called Henry, who came right away. The doctor determined that she was developing bronchitis, which could be very dangerous for Braverman because she has chronic obstructive pulmonary disease.

Rather than send her to the emergency room, Henry started her on an in-home IV containing steroids and antibiotics.

``It was easier to start the medicine in the home, and she responded beautifully, so there was no need to go to the hospital,'' Henry says.

For Braverman, getting visits from Henry is just like the old days, with a twist.

``I get more attention,'' she says. ``She really knows me.''

Diana McKeon Charkalis, [phone]

diana.charkalis(at)dailynews.com

CAPTION(S):

3 photos

Photo:

(1 -- cover -- color) Doctor at your door

Local seniros benefit from house calls' personal touch

Photos.com

(2) Dr. Tamika Henry takes a blood pressure reading while examining Yetta Braverman in the latter's Sherman Oaks home.

(3) Henry sees only six to eight patients a day, which allows her to develop a greater rapport with them. She uses a handheld GPS device to navigate from one house call to the next.

John McCoy/Staff Photographer