It's 8 a.m. on a recent Tuesday, and Aaron Hurowitz, an Atlanta physician, pulls his Grand Marquis into Sandra Powell's driveway. Black bag in hand, he's ready for his first appointment.

"I'm so glad you're here," says Powell, who lives here with her mother. Chestina Sharp, 89 years old, has been in bed since breaking her hip last summer. She watches silently as the doctor rolls down her sock to reveal a purplish sore on her left heel. After a 30-minute examination, Dr. Hurowitz says he will contact a hospice agency so she can get a break. Back in his car, he calls the family's pharmacist to adjust Ms. Sharp's prescriptions.

"I can make house calls on little pieces of time that aren't important to my office practice," Dr. Hurowitz explains, "and we can keep people out of the emergency room."

He can also bill Medicare $180 for a complicated home visit such as this one-roughly $50 more than what he would charge for a comparable office visit. As a result, the 52 year-old family practitioner is thinking about making house calls full-time one day, when he sells his office practice.

At a time when Medicare has cut reimbursements and many medical practices treating elderly patients are in the red, a small but growing number of doctors are reviving the house call to help pay the bills. Nobody knows exactly how many doctors are doing it, but the number of home visits that Medicare paid for shot up almost eight-fold to 1.5 million in 2001 from 195, 700 in 1996, according to the Centers for Medicare and Medicaid Services.

"Interest is picking up," says Peter Boling, professor of geriatrics at Virginia Commonwealth University School of Medicine, in Richmond. In pockets from San Diego to Detroit, he says doctors are making thousands of home visits each month. The national caseload is potentially enormous: At least two million Americans are chronically ill and homebound, Dr. Borling estimates.

Until the 1950's, when advances in medical technology and a boom in hospital construction helped shift treatment almost entirely to the office, nearly half of all doctor-patient contact occurred during home visits. House calls had largely disappeared by 1966, the year the federal government created Medicare, the national health-insurance program covering 40 million elderly and disabled Americans. Reimbursement rates for house calls were set at basement levels and stayed there.

But in the mid-1990's, Dr. Boling and other members of the American Academy of Home Care Physicians, a 700-member group based in Edgewood, Md., began telling regulators that house calls to the elderly were just as complicated and time consuming as the office visits Medicare was reimbursing more generously. After two years of negotiations, Medicare in 1998 finally raised payments for home visits by as much as 50%.

House-call doctors say home treatment for many elderly patients will cost less over the long term than repeated trips to the emergency room, extended hospital stays or even nursing-home care. Home visits are certainly necessary in cases when the alternative would be no care at all, they say.

Some urban hospitals are adding house-call doctors to their staffs. Knight Steel, a geriatrician and director of Hackensack (N.J.) University Medical Center's Homecare Institute, started a house-call practice on July 1 with two doctors and two nurse practitioners. His plan, he says, is "to manage patients at home who don't need to be at the hospital." In Washington, D.C., the Washington Hospital Center started a house-call practice three years ago and now has some 300 patients within a five-mile radius.

"We're able to manage them through chronic illness and make the transition..to end-of-life care," says George Taler, one of two geriatricians involved in the Washington practice. It supports itself financially and has brought the hospital $1 million in business.

Even in less densely populated places, doctors are starting to experiment with house calls. In August, Steven Phillips, a Reno, Nev., geriatrician, decided that more of his elderly patients should be seen at home because they "were having trouble getting into the office," he says. The frailest patients, who make up less than 20% of his practice, were consuming 35% of the office staff's time, he found.

Then he took a look at Medicare reimbursements-as much as $266 for a new patient treated at home, 46% more than the $182 he could bill at the office. "that caused us to go, 'Wow! Let's increase our base,' "Dr. Phillips recalls. He and his partner sifted through their database and plucked out 600 patients who had trouble walking, advanced dementia and other problems that made them candidates for the service. Now, the doctors, five nurse practitioners and one physician assistant have carved up their community into quadrants and spend two-thirds of their time on the road, often checking in with the scheduling nurse using two-way radios.

Among their patients is Georgia Smith, an 87 year old would have to change buses twice to get to their office for appointments. Instead, Dr. Phillips checked on her heart condition at her home about six months ago, and since then, a nurse practitioner has visited, too. "It takes me back to my childhood, when the doctor used to make house calls," Ms. Smith says. "You feel more comfortable with that as an older person."

Doctors can order medical tests for home patients with increasing ease. For example, Dr. Phillips calls on mobile providers of X-rays and electrocardiograms, whom he works with in nursing homes, to test his home-care patients as well. As his home-visit bulks up, he's adding handheld devices that do blood tests.

One big obstacle remains: travel time between patients. "You probably can't break even if you go beyond seven miles between visits, so we try to stay within five miles," Dr. Phillips says.

Proponents worry Medicare will clip payments while they are still scrambling to meet the need. Dr. Taler, of the Washington Hospital Center, worries that a spike in house-call billings could grab Medicare's attention, in the same way the rise of home health aide providers did in the 1990's-resulting in deep cuts in payments. "The same guys who turn on the incentives to encourage doctors to make house calls can very quickly turn them off," he warns.

Still, many doctors are betting on growing demand for house calls-both from elderly patients and their children who shuttle them to appointments. They are certainly welcome news for Gilbert and Olga Corey, who moved to Reno to be near their son. Mrs. Corey age 72, has multiple sclerosis. Her 80 year old husband can no longer lift her in and out of her wheelchair, and so they have a standing appointment once a month with one of Dr. Phillips nurse practitioners.

"prior to World War II, most doctors did make house calls," Mr. Corey says. "Ive seen a lot of changes in 80 years, but I didn't think I'd see them return to this."