The conversation between Dr. Monica Dua and her patient, Roosevelt Copeland, covered wide terrain, including not only his physical status but the cost of his medications, the condition of his wheelchair and the size of his bed.

"I toss and turn a lot -- the next thing I know I was on the floor one time two months ago," the ample-sized 69-year-old told the internist from West Penn Hospital's Home Visit Program.

Dr. Dua peeked in the bedroom of Mr. Copeland's Garfield apartment. Sure enough, there wasn't much room in the standard-sized hospital bed. The doctor would speak to a social worker about ordering a wider alternative for Mr. Copeland, whose physical abilities are impaired by a stroke and kidney disease, among other maladies. She intended to avoid adding fractures to his list of health problems.

"There is a larger-size bed," Dr. Dua noted. "I don't want you falling out of that bed again."

It's the kind of proactive, preventive health assessment that would be difficult for a doctor to make in her own office. That's the value of the Home Visit Program, in which Dr. Dua sees about 15 different homebound patients each week in their own residences, supplemented by a nurse practitioner visiting a smaller number.

These "surveillance" visits, as they're called, are designed to prevent minor health problems from festering and becoming the kind of serious issues that require costly hospitalization. The doctor or practitioner visits the 170 or so patients in the program every few months for about a half-hour, driven from stop to stop by a hospital employee in an SUV.

Without the home visits, Dr. Dua said, "These are people who would probably just check themselves into the hospital whenever something's wrong. ... There are physicians who make a few house visits, but regular practitioners can't really do it."

Dr. Dua is the only Western Pennsylvania doctor listed by the American Academy of Home Care Physicians, which has a membership of about 1,000 health care professionals involved in patient care at home. West Penn began providing the service in 1993, and it has grown slowly by word of mouth and Allegheny County Area Agency on Aging referrals.

Dr. Dua is West Penn's lone physician involved, although she is accompanied by Allegheny General Hospital doctors in residency who obtain training in geriatrics. On a recent morning, she and Dr. Ian Seemungal, a third-year resident, followed Mr. Copeland's visit with one to Mythi Hoang, another stroke victim who lives with her daughter in Lawrenceville, and Enrico DiMatteo, a bed-bound Bloomfield resident who is cared for by his wife, daughter and son-in-law.

Dr. Dua found Mrs. Hoang in much better shape than months earlier, helped along in recovery by a physical therapist and ever-nurturing daughter. The doctor was surprised to learn, however, that a speech therapist had not been visiting.

"We'll see what happened to that," Dr. Dua said, writing a note to herself.

Mr. DiMatteo, a former hospice patient unable to provide any of his own care after a heart attack and other illnesses, was at risk for pressure sores because he spends so much time in bed. Dr. Dua coached his relatives on how to prop one leg -- the other was amputated -- to prevent the skin problems.

With each patient and their caregivers, the doctors reviewed medications, conducted blood pressure and other screenings, discussed progress from prior ailments and reviewed home conditions and lifestyle issues that could affect their well-being.

"This program is great," said Mr. DiMatteo's daughter, Philomena. "Any time you call, they do everything. ... We can't bring him to a doctor -- we'd have to be calling an ambulance every time."

Such programs are a rarity nationwide both because of a shortage of primary care physicians -- especially geriatricians -- and Medicare reimbursement formulas that fail to meet the true costs of making such visits, said Constance Row, executive director of the American Academy of Home Care Physicians.

Medicare might reimburse 10 percent to 20 percent more for house calls, depending on a patient's condition, she said. That could mean compensation of about $20 more for a doctor, which doesn't really cover the time it takes.

"A doctor in an office sees 20 to 25 patients a day, and the typical doctor making house calls in an urban or suburban setting is making between six and eight," Ms. Row said. "There's just no comparison. It frankly is why doctors who have to maintain office overhead cannot make house calls."

There has been some growth, she said, in physician practices that go without standard offices. By shedding fixed costs, they use portable equipment and electronic medical records to spend all of their time visiting patients wherever they live.

Shikha Iyengar, vice president for geriatric services at UPMC, said it has used a program for more than 10 years delivering physical and geriatric care to people at home. Under a team approach, nurse practitioners are generally the ones visiting patients instead of doctors, but geriatricians oversee the program. UPMC has expanded the number of patients seen at home in recent years, she said, recognizing there's value in it for older adults even if they've visited by someone other than an M.D.

"Many times, the older patients, they need a lot of hand holding, of relationship building so they can trust somebody," Ms. Iyengar said.

At West Penn, the hospital helps subsidize the home visits by Dr. Dua as an important community service that also educates the medical residents on how patients live and the cost constraints they're under, said Cindy Carlson, manager of the hospital's Department of Medicine. The hospital's foundation provided a recent $25,000 grant for upgrading of diagnostic equipment that can be taken into patients' homes.

Dr. Dua said her goal is to cut down on as many hospital and medical trips as possible for patients whose strokes, arthritis, hip fractures, dementia or other conditions make it difficult to get out. She arranged for a podiatrist to visit Mr. Copeland about his toenails, but in many cases, she consults with specialists about care she can provide for patients herself because they don't make house calls.

She's happy to serve as a catch-all reference point, talking to other professionals who will look into a new bed for Mr. Copeland, a switch by his pharmacy to lower-cost generic drugs, a replacement of a broken arm rest on his wheelchair.

"I think you're looking good," Dr. Dua told him after checking with a stethoscope and obtaining satisfying responses to a series of questions about Mr. Copeland's breathing, sleeping, medications and other ways he's taking care of himself, assisted by home aides.

"You're being very good, I like that," she said, encouraging the former nursing home patient, who hopes to avoid more time in such institutions. "A few things just need to be done to make things more organized and better off at home for you."

For more information about the Home Visit Program, which is open to Allegheny County residents deemed medically homebound, call 412-683-9590.