Executive Healthcare, Hospital VIP programs, the executive physical and Concierge Medicine? Where does one end and the other begin?
By Michael Tetreault, Editor-in-Chief
Let me first say, I’m going to over simplify things and this by no means is a deep-dive into these programs. However, this article should provide a little insight on these programs, where and why they are in active and successful in our communities and how to learn more about them.
Alright, time to jump in.
Hospitals, Emergency Rooms and some Medical Centers across the U.S. in 2019 are no strangers to incorporating Concierge Medicine programs into their stable of services. They have an obligation to serve their local communities in a multitude of ways. More and more hospitals are looking at ways in which they support and service their local communities. Be that as it may, Concierge Medicine outcome data has been impressive to many of these administrators and Physicians so it is no wonder why some are incorporating high-touch medical care programs into their care.
These facilities have an entirely different set of complexities and challenges to consider though.
If you’re a hospitalist reading this, and yes, many of you probably are, you might want to get your highlighter out.
Asking patients who routinely frequent your hospital to pay a subscription for dare we say, faster, easier and more thorough input from a Physician may not seem fair to some. The concept is not limited to our Doctor’s office any longer. It’s become a successful service line for some hospitals in metropolitan and suburban communities that decide to venture outside of the plan reimbursed primary care and traditional family medicine practice. Physicians and their executive colleagues are looking at Concierge Medicine in the changing landscape of healthcare and wondering ‘Hmmm. How could we make that work here?’
Healthcare isn’t the only sector of business looking into the snow globe of Concierge Medicine either.
Mobile mechanics now have subscription-based programs where you can get your tires, oil change or even brakes replaced at your office while you work. The Concierge Medicine or subscription-based business model has also been studied by cyber security firms and the architectural business sectors.
According to the Business Observer in June of 2019, Baron Schimberg’s latest move to break the contentedness is to flip his firm’ payment model, from a project-by-project basis to a retainer model, more akin to concierge medicine. Schimberg, who founded his firm, Schimberg Group, in 2004 after a decade working for another architect, says he’s the only architecture firm he knows of nationwide shifting to a retainer-style pay model.
Concierge Cyber™ is modeled after the highly successful and growing practice of concierge medicine, which has proven to result in positive outcomes for both the patient and the physician.
Emergency Rooms and hospitals exploring these concepts might seem uncommon and downright peculiar. However, it has also been around for years. These programs operate similar to an annual Concierge Medicine memberships but may also have charges for each visit and/or work with insurance and Medicare. In return, patients get access and more time with a doctor, at the hospital.
Before you think ‘Wow, how much does that cost?!’ and think this is only for the ultra-wealthy, please understand that the Physicians who are operating in this programs are doing it for the right reasons. And, the patients appreciate the time, attention and compassion they receive in the program.
You might not be aware but the first, Medical Centers Concierge Alliance Conference targeting Hospital Physicians, Administrators and Medical Center Executives was held in Seattle, WA in August of 2013. The Dare Center of Seattle, WA invited concierge physicians, hospital administrators and medical center executives from across the country who participated in a round table discussion.
At least 20 medical centers were represented at this meeting.
The Lewis and John Dare Center at Virginia Mason Medical Center in Seattle has been a model for concierge medical care and unique primary care programs for a number of years. In August 2013, the Dare Center invited concierge physicians, hospital administrators and medical center executives from across the country to participate in a round table discussion. The inaugural event took place in Seattle, WA.
Representatives from The Lewis and John Dare Center at Virginia Mason Medical Center the discussion. John Kirkpatrick, MD, a Dare Center physician, was one of the main speakers and noted that the focus of the meeting was to bring together staff members of medical centers with existing concierge programs to discuss common problems and share successful solutions. At least 15 medical centers attended this meeting. There was a breakout session for program managers in established practices and another for attendees exploring this type of practice, as well as a round table discussion with “lessons learned” from other programs currently operating in the marketplace.
Other topics at the meeting included:
- alternative models;
- preserving academic standards;
- legal hurdles;
- marketing tips;
- compensation issues;
- networking and
- other topics important to successful medical center operations.
There was a breakout session for program managers in established practices and another for attendees exploring this type of practice model. Topics also included: alternative models; amenities/perks; preserving academic standards; legal hurdles; marketing tips; compensation issues; expectations/boundaries; recruiting; networking and other topics of interest.
“The challenges of medical center Concierge Medicine programs are very different than those experienced by concierge physicians in private practice,” said Dr. Kirkpatrick. “All hospitals/medical centers have special perks and usually enhanced access to specialists for their donors and patrons, often a special number they can call. Most have an informal private banking approach where there is no established fee, just an expected level of donation. Despite the proliferation of individual concierge practices and now organized networks, Concierge Medicine programs inside medical centers are quite unusual. There may be only 20-25 in the entire country.”
So when implementing a Concierge Medicine program in a local hospital for the first time the physicians who currently and formally retired that work with these subscription programs say they are typically primary care doctors, family physicians and some currently employed hospitalists that staff the program(s). So as more physicians are turn to these facilities for employment, patients are also lining up to sign-up.
Coincidentally, on June 6, 2019 The New York Times reported on this topic specifically, stating …
Clinics are trying to improve the experience to get women to show up for regular appointments. Standing out from other health care providers gives hospitals some power with insurance networks. Normally, they must agree to low prices to be admitted into insurance networks, but having unique offerings that patients want gives them some leverage, said Laurence C. Baker, the chair of health research and policy at Stanford. Hospitals can then say “‘Hey, you need to have me in your network because patients want to come see me,’” he said. The risk, he said, is that hospitals become divided places for the haves and the have-nots. That’s something that’s already happening, with concierge emergency rooms, private medical groups charging annual fees of up to $80,000, and more organizations like Tia Clinic, a members-only doctor’s office for women in Manhattan. Across the country, other mammography providers are ginning up other enticements. UConn Health’s mammogram clinic serves pretzels, graham crackers and juice. Skyline Hospital in Washington State hosted a spa day last fall, also with snacks. Yoakum Community Hospital in Texas has added a chandelier and scent diffuser to its mammography area. Even medical supply companies are getting into it. General Electric, which sells mammography machines, now offers a tricked-out version which spritzes out a “light calming fragrance,” according to G.E. marketing materials.
Furthermore, in April of 2018, The New York Times again wrote a story entitled An E.R. That Treats You Like a V.I.P. In the article they stated…
Top hospitals have also started to provide concierge services, offering programs with stately names that are meant to coddle dignitaries, celebrities and international patients paying their own way. In New York, Mount Sinai Hospital has its Executive Services Department, the Hospital for Special Surgery offers its Ambassador Services, and Weill Cornell Medicine provides its International Patient Services … Dr. Bernard Kruger, a board-certified physician in oncology and internal medicine, started the company 18 months ago with two partners. He had a concierge medical practice for 15 years but saw its limitations, particularly on weekends if a patient was hurt and needed an X-ray or blood work. He got the idea for a concierge emergency room after helping a patient, an actress, who had fallen off a horse. “I brought her to Mount Sinai,” Dr. Kruger said. “The head of the department came down. We still waited five hours for a CAT scan. I said something is wrong here.” The Priority Private Care facility is sleek and modern, with a Chuck Close painting hanging on the wall. In addition to being well staffed, the center has the imaging machines and laboratory equipment for blood work to get results quickly and help doctors make a diagnosis. Dr. Kruger summed up the experience: “You get seen right away. You get treated right away. You have a consistent doctor with you.”
So what are the Top Five Considerations Institutions Should Consider When Exploring Concierge Medicine? We talked to Dr. Kirkpatrick a few years ago before he retired and found out:
- The CEO MUST be supportive and the overall organization MUST embrace the concept. This cannot be over-stated.
- The program needs a Champion. This can be the CEO, or a doctor who is going to provide the care, a VP of Marketing/Business Development, a VP of Foundation or Development Department. Someone must keep the program moving forward. Someone with the clout to promote and do it.
- The Medical Center should have a well-to-do population base of interested Patients. This program works for Mayo in the Phoenix, AZ area and in Jacksonville, FL but not Rochester, Minnesota.
- The Medical Center needs two doctors who already provide personalized services to their Patients.
- Steering committee of stakeholders – Patients, providers, senior administrators, development officers, marketing experts, nursing staff.
MD² CEO, Peter Hoedemaker says “Time is just so critical. By limiting their total number of families they have the ability to accompany patients to specialist visits, navigate their care through hospital stays and truly research every ache and pain. It’s like having a physician as part of your inner circle, as if they’re a member of your own family.”
Physician, Dr. Robert Nelson of Atlanta GA said “Primary Care needs to become relevant again by servicing patients directly and being available and offering the kinds of broad services that family doctors used to offer. Only returning to broad-based primary care that is affordable, getting back in the hospitals and being available to keep our patients out of the ER and urgent care will solve this supply-demand imbalance. This kind of approach will also drive more medical students back into primary care and restore the balance back to the ratios before managed care.”
Other very important steps include approval of the legal department and development implementation of an internal marketing plan for education of all staff. This should be performed even before external marketing begun.
What are the Differences Between Hospital Executive Health Programs and Concierge Care?
Great question. It’s easy to think a Hospital-based Concierge Medicine program, a Concierge Doctor or an Executive Health program with concierge service is the same. They might seem like nearly identical vehicles at first glance. When you look under the hood, you see a different engine.
Let’s look at a couple of examples to help unpack the differences and similarities.
For example, Vanderbilt Executive Wellness and Concierge Medicine [which] accommodates individuals who are seeking to establish a primary care doctor with advanced personal access. Our doctors are always accessible for you, so you can save valuable time when a healthcare need arises. And, the Concierge Executive Health Program from Metro Health (Wyoming, Michigan) offers executives – and anyone in the community who desires a more convenient and full-service approach to their health – the opportunity to get more from their health care. It provides access to streamlined, comprehensive annual health assessments and services, with personalized care and fast results. You also have the peace of mind knowing you’re getting the ongoing care you need to stay on top of your health, while receiving the benefits of easy scheduling, streamlined appointments and concierge services that provide a highly personalized level of care.
According to the Walter Reed National Military Medical Center, they define Executive Medicine as being responsible for providing all of a patient’s health care needs and/or arranging care with other qualified professionals, This includes coordination of preventive and specialty care, treatment of acute and chronic illness and case management services.
A Concierge Medicine Doctor can conduct an executive physical. For example, PartnerMD, a concierge practice in Virginia with multiple doctors’ states that … [PartnerMD] provides executive physicals that are sure to attract and impress top talent while providing comprehensive, actionable insights for achieving optimal health. (Source: https://www.partnermd.com/corporate-health/executive-health-physicals/)
So, in relation to executive health programs with a concierge flare, think of these as high-tech, high-touch examinations for executives that don’t always have a subscription attached to them … but might be paid for by the company, the executive directly or the executive’s insurance for a battery of services, labs and tests each year or every few years. This battery of tests may last one day to two weeks followed by a few Physician visits and specialist consults. Long-term, the relationship with those particular physicians may end when the physical examinations and test results are completed and care is then moved to the executives PCP for further follow up.
That might be over simplifying it, so our apologies.
10 Top Executive Wellness Programs – Even at the highest end, healthcare can be frustrating. But executive health programs have emerged as a solution—here are 10 of the best programs around the country.
Another example, The Johns Hopkins program. The Johns Hopkins program is comprised of a team of doctors specializing in preventative care and patient-doctor communication, among other areas. One-day consultations include everything from an EKG and comprehensive blood testing to eye, ear and dermatology screening and nutritional counseling. A host of optional tests are available as well, including a colonoscopy, exercise stress test and body-fat analysis.
So when we examine a hospital-based concierge medicine program we find that they may gear their program to executives or a larger community of patients.
Even at the highest end, healthcare can be frustrating. But executive health programs have emerged as a solution—here are 10 of the best programs around the country.
~WORTH Magazine; Benjamin Reeves; Oct 7, 2014; 10 Top Executive Wellness Programs | https://www.worth.com/10-top-executive-wellness-programs/
For those programs servicing a larger community of patients, those programs usually have a fee-based health structure (usually, but not always billed annually) and in turn, provide Patients, donors, etc., with a dedicated concierge doctor and specialized care team. This may allow for faster coordination and communication between the concierge doctor and a nearby oncologist or radiologist already working in the facility.
For example, when you join Stanford’s concierge medicine program, you’re investing in your well-being. You will have a one-to-one, customized health care program founded on the close relationship you will have with your dedicated doctor. And you’ll enjoy a range of conveniences and first-class care to fit your health, work, and lifestyle needs. (Source: https://stanfordhealthcare.org/medical-clinics/concierge-medicine/faq.html)
RELATED STORY | EXECUTIVE HEALTH PROGRAM | FORBES
The $5,000 Checkup
According to American Express, they estimate that an executive physical cost, dependent upon the depth of the tests and time spent with the Physician(s) can come at a cost of $2,500 to $10,000. This really depends on which tests might be conducted … With advancements in healthcare and increasingly discriminating prospective patients, executive health programs are going to evolve. This evolution is a function of advances in medical technology and care, more demanding patients able to afford the healthcare advances, and the economic needs of the hospitals and medical practices.
The University of Miami UHealth Executive Health and Concierge Medicine program wrote an article announcing their personalized medicine approach and explained the differences between Concierge Medicine programs and Executive health programs quite well. In the article dated January 22, 2019, they said …
Executive health and concierge medicine are two different models of care. Executive health involves a single visit of several hours with a set fee. The UHealth executive program consists of a thorough physical examination, blood work, cardiovascular screening and pulmonary evaluation, and consultations with a nutritionist and an exercise physiologist. There usually is not a continuity of care component unless something is uncovered that requires follow-up consultation or treatment.
“The individuals we see in executive health are high achievers who have a lot of stress in their lives, but only about half of them are business executives,” Dr. Avallone said. “The other half may be teachers or firefighters — people in other professions with long, demanding work schedules who don’t have a lot of free time for doctor’s appointments — and international patients who fly in to Miami knowing they can complete their examinations and tests in a single day. What they all share is a desire to take a proactive approach to their health care. They come to us for our expertise and to get peace of mind. Some of them may not have seen a doctor in years and are fearful of what the exam may find. Our first job is to build a relationship based on trust, to let them know that coming in was the right thing to do, and to give them as pleasant an experience as possible.”
“Maintaining proper sleep, diet and exercise are very important for all of us, but it can be a real challenge for our patients who travel a lot,” Dr. Pravia said. “Our experts can give them tips that will help them come home as healthy as when they left. And if the examination does turn up a medical issue, we can have them meet with a specialist. That’s the advantage of being at an academic medical center. The patients don’t have to be referred out and spend weeks going from appointment to appointment.”
By contrast, concierge medicine is a membership model in which patients pay an annual fee not only for an annual expansive physical exam, but also for 24/7 phone and email support toward patient health education and annual exam health goals. The smaller concierge practice panel and substantial electronic communication connection translates into easier scheduling of appointments — typically an hour, since plan reimbursement requirements are not restricting appointment length and annual exam goal coaching is included — with their physician. The two programs are not necessarily mutually exclusive; an executive physical patient may choose to become a concierge medicine member for ongoing health care needs.
“A physician in a typical practice might have 2,000 to 3,000 patients; a concierge practice physician might have 300 to 600 patients. This smaller and more connected practice model builds stronger doctor-patient relationships, providing health care in a more efficient, effective manner. You promote wellness and prevent disease, rather than trying to catch up with disease once it has developed,” Dr. Avallone said.
“As a clinician, you are able to spend more time with the patient and not be looking at the clock,” Dr. Pravia said. “You get to know the patient better and talk about health-related issues that might not come up in a shorter appointment. You can make more informed recommendations that result in better outcomes for the patient. That, in turn, helps build your practice. Word of mouth is essential, and if a patient likes their physician, they will tell their friends and family members.”
Both physicians find these personalized forms of medical practice extremely satisfying.
“As a doctor, keeping people healthy and helping them achieve optimal health is very rewarding,” Dr. Avallone said. “That’s our job, and it’s why most of us went into this profession. We’re here to make sick people better and keep healthy people well. If we do our jobs well, our patients benefit, the people around them benefit, and it makes for a healthier community to live in.”
The latest (2019) examples of Concierge Medical Care Programs & Concierge Executive Healthcare programs currently being used inside hospital and institutional environments include (just a few):
- Concierge Medicine (Dare Center) – Virginia Mason
- Metro Health Concierge Executive Health Program
- Concierge Medicine at UC San Diego Health System
- New York-Presbyterian/Columbia University Medical Center and New York-Presbyterian/Weill Cornell Medical Center
- Northwestern Executive Health
- Vanderbilt Executive Wellness and Concierge Medicine
- Vanderbilt Executive Wellness and Concierge Medicine accommodate individuals who are seeking to establish a primary care doctor with advanced personal access. Our doctors are always accessible for you, so you can save valuable time when a healthcare need arises.
- Penn Personalized Care
- Massachusetts General Hospital’s Concierge Medicine Program
- The state-of-the-art practice opened in the fall of 2016 and is conveniently located on the tenth floor of 50 Staniford Street in Boston, adjacent to the main campus of Mass General. Learn More …
- Duke Executive Health
- Stanford’s concierge medicine program
- In February of 2019, Boca Raton Regional Hospital (BRRH) today announced Aaron Klein, DO, joined its BocaCare® physician network and will offer a concierge medicine option to the network’s patients. This initiative represents the first hospital-based concierge medicine program in Palm Beach County. (Source: https://www.brrh.com/Newsroom/2019/February/BocaCare-Now-Offering-Concierge-Medicine.aspx)
- Executive and Corporate Health Center – Emory Healthcare
- Executive Health Program – Mayo Clinic
- Executive Health Program – Cleveland Clinic
- Executive Health Program – California Health & Longevity Institute (CHLI) a medical clinic and wellness center tucked into this $300 million hotel spa
- University of Chicago Medical Center
- North Naples Hospital
- University of Iowa Hospitals and Clinics
- Mount Sinai Hospital Executive Health
- New York University Tisch Center for Men’s Health
- Cleveland Clinic Executive Health Physical Examinations
- University of Miami Health System Concierge Care Program
- The Johns Hopkins Executive & Preventive Health Program
Other Popular Executive Health Programs
- PinnacleCare: Private Health Advisory
- Executive Medicine of Texas
- MSK Direct | Memorial Sloan Kettering Cancer Center
- Comprehensive Longevity Planning.
- The cutting edge hospitals will integrate both genomic and biomarker testing with the design of a holistic and enduring preventive healthcare and risk management plan
CMT SPOTLIGHT: Meet Dr. Espinosa — “Making the Switch From Hospital to Concierge Practice.” ~J. Colwell