A true ministry

When she started Jubilee, Inouye didn’t anticipate having to live on a fraction of her former income, mainly off her retirement savings.

Dr. Inouye asks Harriet Small if the two of them can pray together.

Divorced with three grown children, she certainly didn’t envision standing in the grocery line and discovering that she was short on cash and had to return some of her food.

“That was very hard for my [youngest, college-age] daughter the first time it happened, but you learn to live on what you have,” she said. “I also have evidence that the Lord uses the famine we’re in to grow us.”

While some private insurers and a few patients have paid her directly, claims to Medicare for the bulk of her patients have been rejected, she said, in part because the practice doesn’t maintain an office. She has supplemented Jubilee by working part time in area emergency rooms and urgent care centers.

Carroll said they’re hopeful that an appeal will eventually lead to payment. “I’ve seen a roll of eyes when I’ve said this before, but today is the only day we’re given,” said Carroll, who not only schedules the doctor’s appointments but also visits patients to read Scripture. “That means I’m not chasing after stress with regard to the payment situation.

“I’m not doing this for pats on the back, or for people to come in and fix the problem,” Carroll added. “I’m doing it to serve the Lord.”

Across the country, many house-call physicians have had to fight to be reimbursed, according to Johns Hopkins Medical Center professor Jennifer Hayashi. “House-call billing is met with a disproportionate amount of suspicion and confusion,” she said, because of “an unfortunate history of fraud and abuse among home-care agencies and a general dearth of knowledge” about physician house calls.

“Politically, home-care docs are the Willie Hortons,” added Dr. Tom Kline, a leader in the physician house-call movement. Like Inouye, the Boston doctor operates out of his home without an office. Though he is reimbursed by Medicare, he’s had to aggressively battle agency auditors who frequently question his bills.

By treating people at home, “We are the only group of doctors that actually keep people out of hospitals, which means we’re truly saving Medicare money,” Kline said, adding that a typical geriatric emergency-room patient can cost from $40,000 to $60,000 in hospital and rehabilitation-facility care.

For the time being, Inouye and Carroll say that feedback from their patients is payment enough. “We’re reinforced virtually every day that this is important, and it matters,” Carroll said.

Enabling people to walk across a room or, more profoundly, praying with them to relieve a guilt they’ve clung to for decades, “That’s life-changing ... that makes a difference,” Inouye said.

Of the caregiver whose bedroom she helped clean, Inouye recalled asking the wife if there was anything else she wanted help with before her husband passed away.

“The one thing I’d like is to be able to hold him, but I can’t get into his hospital bed,” the woman said.

Inouye thought otherwise. Before she left the house, she scooted the man over in his bed to make room. Then, she pulled a chair up next to his bed and told her to climb in.

He died two days later in his wife’s arms.