Raymond Hasson is an 83-year-old retiree living on a fixed income in Lake Worth, Fla., a suburb of West Palm Beach. Hasson, a former journalist, is acutely aware of the cost of healthcare and employs an elaborate strategy involving Wal-Mart, his HMO and telephone orders to Canada and other countries to keep his prescription drug expenditures under control.
But when it comes to his primary care physician, Hasson gladly plunks down the $1,500 a year it costs to be one of the limited number of patients who receive personalized care from Dr. Andrew Schlein and his concierge medical service.
“He’s a great doctor, and I wasn’t going to give him up for a lousy $1,500 a year,” Hasson says. “He’s worth a million bucks to me. I’ve been with him for 11 years.”
Joel Wood, the senior vice president of government affairs for The Council, feels the same way about the care he receives from Dr. Jeffrey Graves, the medical director at the Greenbrier Clinic, which offers a range of executive health services to guests of the posh resort in White Sulphur Springs, W.Va.
“I am addicted there,” says Wood, who started going to the clinic for his yearly tests and physicals years ago when The Council held its fall membership meeting there. “You could foreclose on my house, my family could leave me, my retirement savings could be ruined. But the last thing I am going to let go of is my doctor at the clinic.”
The public debate about healthcare reform frequently focused on the tens of millions without health insurance or the millions more who were underinsured. But there is another side of the discussion that rarely finds its way into headlines. Specialized care has long been available at world-renowned hospital centers around the United States, such as the Mayo Clinic in Rochester, Minn., the Cleveland Clinic in Ohio and Johns Hopkins in Baltimore. Taking advantage of those services are VIPs, celebrities, the very wealthy, well connected foreigners and members of royal families, many as “private pay” patients with no insurance coverage.
But in recent years, more people have taken advantage of such exclusive healthcare services. Some are high-powered business types who enjoy the benefits of executive care programs that bundle a huge number of tests and procedures into a single visit in deference to their busy schedules. Others are Regular Joes like Hasson or Wood, who pay extra to be part of a limited-patient medical practice that provides more personalized services for a fee they consider reasonable.
Pay-for-privileges medicine has been around for more than a dozen years, but it has picked up steam recently as the combination of increased patient load and multiple treatment options have left both doctors and patients feeling frustrated. It has become so hip, in fact, that the USA cable network launched a television series, “Royal Pains,” featuring a young doctor who begins a concierge care service in the trendy Hamptons.
Typically, for an additional $1,500 a year, patients can be among as many as 600 people cared for by a single primary care physician. Each patient receives an annual physical (similar to an exam one would receive at a premier hospital) and round-the-clock access to the doctor. There are no house calls, but a patient is guaranteed to get an appointment quickly in non-emergencies and the same day or the next for medical emergencies.
“I have his office number and his cell phone number, and he encourages me to call him every time I have an issue,” Hasson says of his doctor. “I am not going to call him for little piddling things, but I have the security of knowing I am going to get him, not his answering service, and not the guy who is covering for him and may not care about calling me back.”
Hasson says his doctor joined MDVIP, one of the leading concierge networks in the United States, because he “used to see 50 patients a day and thought he was burning out, so he got into this program to reduce the pressure.”
Dr. James Burford of Greenville, S.C., joined MDVIP a few years ago for similar reasons. Burford calls the decision “the logical conclusion to the evolutionary changes in medicine.” When he started practicing in the early 1970s, there often was only one treatment available for any given condition, and a patient’s problem generally could be dealt with in a 10-minute appointment. Today, doctors spend more time making their diagnoses, weighing the symptoms and discussing options with their patients.
“It takes more time, and if you don’t allocate the time, the patient does not experience the benefit of this improvement of knowledge in the medical field,” Burford says. “I was seeing a lot of patients and trying to put a pound of candy in a half-pound sack. It wasn’t working. Patients were angry with the wait, and I felt there might be something I would have to omit because I didn’t have the time. I was frustrated that I wasn’t providing what I considered the standard of care that was achievable.”
When Burford joined MDVIP, he had nearly 2,000 patients. Today every one of his 600 patients is guaranteed a 30-minute office appointment, no matter how minor the problem. A thorough physical, including laboratory tests and an extensive review of all findings, is included in the fee. Other services are billed to a patient’s insurance, as would occur in a typical physician’s practice.
Wood also goes through a full range of annual tests at the Greenbrier Clinic, from blood work and heart scans to nuclear stress tests. One of the benefits of the setting, Wood says, is that everything can be done at the same time. He says the cost of this executive health service is “a lot more” than his employer-provided insurance covers, but the insurance coverage has been “appropriate” and his out-of-pocket expenses well worth it. In addition to getting special tests and attention due to a family history of serious cardiovascular problems, Wood has a chance to talk at length with his doctor about anything else that may be bothering him. One such conversation might have saved his life.
“Seven or eight years ago I mentioned that every once in a while I had to take pains to really chew foods because swallowing was just a little uncomfortable, and the food didn’t always go down right,” Wood recalls. “I mentioned this to the doctor in passing when he asked if there was anything else bothering me. Two hours later, I was under anesthesia with a gastro specialist and was getting an upper GI.”
It turned out that Wood was diagnosed with “very severe” esophagitis, a precursor to cancer of the esophagus, which is almost as deadly as lung cancer.
“I am not sure I would have ever gone to my doctor about it, but in sort of an off-handed way, I mentioned it because he was probing,” Wood says. “You can’t leave that stuff untended because it could lead to one of the worst kinds of cancer.”
Graves says one of the biggest advantages for his executive patients is that both the screening exams and a symptom-driven physical exam can be done “in a very relaxed, comfortable setting” in about a day and a half.
“I frequently have executives say, if it is going to be done, it has to be done today and now because when I get back to work, I won’t have the time,” Graves says. “We recently had a railroad executive who was here for his 55th physical, and we have a lot of people who have been coming here for 30 or 40 years. I recently had a very busy executive who told me on his second day, ‘I haven’t been to a doctor for 10 years because I hate doctors and I hate the procedures, but I am coming back here next year because this isn’t going to the doctor.’”
One of the reasons the Greenbrier and other executive health clinics work is because they facilitate the scheduling of all appointments, consultations and other services, allowing their busy patients to make the most efficient use of their time.
Hospitals as Upscale Hotels
Top-of-the-line hospitals have long known that providing concierge-style services, from luxury hotel-style rooms and travel arrangements to language translation services for foreign patients, can benefit not just the hospitals but their communities, which receive an added economic boost from the deep-pocketed patients—and, in some cases, their entourages.
Hospitals that offer these services stress that the quality of care they provide to celebrities and the very rich is equal to the care they provide to all patients. The atmosphere where the care is delivered, however, can be markedly different.
“If you need a heart transplant, you don’t move up on the list,” one official at the Cleveland Clinic says. “You are still getting the same level of treatment. It just becomes more comforting for people traveling away from home. If they are used to a certain lifestyle and services, we can make those available.”
Wealthy patients who will be at the hospital for a long period of time often stay at a luxury hotel rather than at the hospital. If they need to remain in the hospital, the VIP rooms offer more space, privacy and amenities, including pull-out beds for family members, special food services and adjoining rooms for family or security details.
In 2008, patients from 80 countries came to the Cleveland Clinic for treatment. The Mayo Clinic in Rochester, Minn., has long been a magnet for members of royal families from the Persian Gulf, who book multiple rooms at the lavish Kahler Grand Hotel, whose 22 suites fetch up to $3,500 a night. So great has been the influx of Middle Eastern patients that Mayo built a private mosque in the hospital complex.
In the fall of 2008, a Saudi Arabian Airlines 747 arrived in Rochester bringing Saudi Arabian King Abdullah bin Abdulaziz to Mayo for a physical exam and several days of tests. Bloggers on the Rochester Post-Bulletin’s website reported seeing a motorcade of Rolls Royces pulling up to the Kahler Hotel and stopping traffic around town as the royal entourage engaged in power shopping.
In Cleveland, stories abound of rich foreign visitors and celebrities who have rented entire floors of hotels and retrofitted them to their needs or spent millions renovating a house only to put it back on the market within a few months after their treatment was completed.
Hospitals that offer such services say it is their outstanding reputation for specialties of care that makes them a magnet for the very rich or the very special. But officials don’t dispute the suggestion that making everything easier and more comfortable for the private pay patient and his or her family often makes the difference between seeking care in the United States or traveling to London or Germany.
One Yes, One No to Concierge Service
She said no.
Helen Moorhead of Greenville, S.C., had been seeing Dr. James Burford for about five years when she learned he was planning to change his general practice into a concierge medical service that would require her to pay $1,500 a year for a more exclusive care relationship.
She attended one of Burford’s informational meetings to learn more about the program and ultimately decided it was not worth the extra money. But she said the prospect of change was not as hard for her as for many of the other patients, including a number of seniors who had been with Burford for a longer time.
“I have no health issues, so it wasn’t as big a deal for me as it might have been,” Moorhead says. “There were some very emotional people at the meeting I went to. Most of them were older people. They were saying, ‘You’re just giving us up for the rich.’ There is just a small group of people who can afford to do this. Most of them had been with him for a long time.”
Moorhead says she understands their concern because, when you have a good relationship with a doctor, it is hard to find someone to replace him or her. It took Moorhead nearly 18 months to find a new doctor she likes.
“I know five people who stayed with Dr. Burford, and all of them had some issues he was helping them with,” Moorhead says. “They did not want to leave him right then. It was worth it to them to pay the money to stay with him.”
She said yes.
Emily Helms of Greenville, S.C., has been with Dr. James Burford “for so long he and I have gotten gray hair together.”
At first, she and her husband, Ken, a pharmacist in Greenville, were not going to ante up the extra $1,500 to join Burford’s concierge service, but they reconsidered.
“We talked about it and both decided that right now we would do this because we could afford it,” says Helms, who is retired. “After my husband retires or cuts back”—and they cannot afford the extra $3,000 a year—“we will switch to another doctor.”
“I know people who go to him who feel exactly the same way I do and are going to stick with him, too. They had a couple of health situations where he really dug and dug until he figured out what was going on. He is very smart, reads all the time and keeps up. We trust him a whole lot.”
Helms understands why Burford made the change.
“He likes to see me every four or five months, and he does frequent blood work because I have high cholesterol and other things. It used to be I’d get the lab work done, and it would be several weeks before I got in. It used to be he was in and out of there in 10 or 15 minutes,” she says. “This last time, I got an appointment the next day to get my lab work done, and I saw him a week later. He was with me 40 minutes. He just seemed much more relaxed and less rushed. That is the kind of doctor he is. He is very, very thorough, and he wants to practice medicine the way he wants to practice it.”