Why primary care at home matters in Washington
A doctor’s appointment can take half a day for someone who lives outside Washington: the drive in on two-lane roads, the wait and the drive home. In bad weather, or when the family member who drives is working, it gets harder still. In-home primary care follow-up cuts down on those trips. Gateway arranges visits with a partner clinician at the patient’s own home, coordinates any lab work or tests that clinician orders, and sends visit records to the other doctors involved, so fewer errands require the highway.
In Washington you will find older houses near the riverfront downtown, newer subdivisions on the edges of the city, apartments, and farmhouses and homes on acreage in the countryside beyond. Senior apartments, assisted living and skilled nursing facilities serve the city and the smaller towns around it. Gateway arranges visits with partner clinicians in these settings. Because Washington is farther out than most communities we coordinate, we confirm availability by address before anything is scheduled. Clear directions matter on rural routes, so we ask for them.
For the full range of services, see primary care in St. Louis, including house calls, annual wellness visits and follow-up after a hospital stay.
What the clinician can look at
Primary care at home is not only for times when something is wrong. A yearly wellness visit looks ahead. It is a planning visit more than a physical exam: a review of your health risks, questions about memory, mood and falls, and a schedule for the vaccines and screenings that fit your age and health. Some people also use it to talk through the care they would want during a serious illness. See annual wellness visits for what to expect.
Between wellness visits, follow-up covers the everyday work of primary care: managing long-term conditions, reviewing medications, checking in after a hospital stay, and ordering lab tests or specialist visits when the treating clinician decides they are needed.
People who benefit most
Getting to a doctor’s office is the hard part for many people in Washington. Stairs, a wheelchair, an oxygen tank, no longer driving, or needing a second person just to reach the car can turn a short appointment into a full day. In-home primary care is arranged for adults in that position, whether or not they think of themselves as homebound. Our page on primary care for homebound adults goes into detail.
It also suits people recovering from surgery or living with a wound, residents of assisted living, and anyone whose longtime doctor has retired or moved and who has gone without primary care since.
Primary care and wound healing
A wound on the leg or foot needs blood flow to heal, and checking circulation is partly a primary care job. The primary care clinician asks about leg pain with walking, checks the pulses in your feet, reviews risks such as smoking, diabetes and high cholesterol, and decides whether a circulation test or a vascular specialist is needed. The page on circulation and vascular health explains the basics.
Those results matter to the wound care clinician, because poor arterial flow changes which treatments are safe, including compression. Gateway sends test results and specialist notes to both clinicians, so each one is working from the same facts.
Homes, assisted living and skilled nursing
Skilled nursing works differently from the other places where Gateway arranges primary care follow-up. Every resident already has an attending physician who is responsible for medical care, and facility nurses carry out the orders. We do not replace that team. In facilities in Washington, we coordinate with the attending and the nursing staff, and we plan follow-up for the day a resident leaves. See primary care follow-up in skilled nursing.
After discharge, a partner clinician can visit at the next address, whether that is a private home, an apartment, assisted living or memory care.
Working with your existing doctors
One question clears up a lot of confusion: who do I call for what? When several offices are involved, a refill request or a new symptom can bounce between them. At the start of care, ask the treating clinician’s practice how to reach them between visits and which problems should go to them, to your longtime physician, to a specialist or to the home health nurse. Write the answers down and keep them by the phone. For scheduling, records, supplies and anything that seems stuck, Gateway is the number to call.
How to arrange a visit
Here is what follows a call to 314-325-0126. First, we confirm whether a partner clinician is available for your address in Washington and for your type of residence. Next, with your permission, we request records from your doctor’s office or the hospital you were in, so the clinician arrives informed. Then we schedule the visit. After the visit, we follow through on what the clinician ordered, whether that is lab work, equipment or a referral, and keep the people you choose up to date.
- County: Franklin County, Missouri
- ZIP codes: 63090
- Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
- Nearby communities: Franklin County, Eureka, Wildwood
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
What to ask about your plan
Before a first home visit, a call to the member number on your insurance card can answer most cost questions. Useful things to ask:
- Does this practice participate in my plan?
- Do I need a referral or prior authorization for visits at home?
- What would I owe for a visit?
- Are lab work, imaging and medical equipment handled differently?
Write down the date, the name of the person you spoke with and what they said. Gateway can give you the name of the treating practice to use for that call.
Common questions
Can my spouse and I both be seen during one home visit in Washington?
You can ask for that. Each of you is a separate patient, with your own records, your own coverage questions and your own visit. When one partner practice can see both people, we try to line the visits up back to back so the household has one appointment time. Whether that works depends on clinician availability, so we confirm it when scheduling.
Do I need a referral for primary care at home in Washington?
No referral is needed to call Gateway. Patients, family members and caregivers can contact us directly, and so can hospitals, facilities and physician offices. Your health plan is a separate matter. Some plans ask for a referral or an authorization before certain services, and that depends on the plan and the treating practice. We go over what to check before a visit is scheduled.
Does Gateway arrange primary care in Washington for people who do not have a wound?
Yes. The company name says wound care, but you can ask about a primary care clinician who visits at home whether or not you have a wound. Long-term conditions, a recent hospital stay or simply being unable to get to an office are all reasons to call. If a wound does develop later, having primary care already in place makes it easier to coordinate both.
Can blood pressure or blood sugar be tracked between home visits in Washington?
Sometimes. If the treating clinician decides it would help, a program called remote patient monitoring uses devices such as a blood pressure cuff or a scale that send readings from your home to the practice. Whether it is offered depends on the practice, your plan and your condition. A written log you keep yourself is also worth showing at each visit. See remote patient monitoring.
Can in-home primary care in Washington help me get a walker, hospital bed or other equipment?
The treating clinician decides whether equipment is medically needed and writes the order. Gateway then works with the equipment supplier on the paperwork and delivery details. Health plans have their own rules about which items they pay for and what documentation they want, so having an order is not the same as having approval. Ask what you might owe before delivery.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.