Al Newland engineered his own health-care reform a little more than a year ago. His son, Martin, then 13, was sick for several days with fever and stomach pain. The family’s doctor in Vienna waved off the symptoms, but Martin grew weaker and unable to hold down food.
Four days after the trip to the doctor, Newland took his son to the emergency room at Inova Fairfax, where the underlying problem was diagnosed: Martin’s appendix had burst. The complications were serious enough that the teenager was hospitalized twice and lost 40 pounds. For more than two months, he took antibiotics intravenously every six hours.
With that, Newland left the Vienna practice—“They treated you like a number,” he says—and on a friend’s recommendation signed up himself, his son, and his wife, Nancy Heaney, with PartnerMD, a company based in Richmond that had opened a McLean practice.
PartnerMD is the latest entry in “concierge medicine,” a primary-care model that is booming as dysfunction within America’s health-care system grows. Patients in a concierge practice typically pay an annual retainer or membership fee of $1,500 to $3,000. Doctors in turn reduce their patient load—from as many as 3,000 to typically about 600—and promise same-day appointments, 24/7 access to physicians, and lots of preventive screening.
The payoff for the doctor can be attractive: A $1,500 retainer for a practice of 600 grosses $900,000. “That’s serious money before you even say hello to a patient,” says Peter Lavine, an orthopedic surgeon and president of the Medical Society of DC. For patients, the arrangement also can be very attractive. No more cooling your heels in crowded waiting rooms. No more hurried consultations with a doctor who can’t remember your name.
Some worry that concierge care sharpens the divide between the haves and the have-nots. But the model is cheered by others as the seed of a health-care revolution.
Concierge care debuted in Seattle in 1996 and has captured the interest of a relatively small number of doctors. The Society for Innovative Medical Practice Design, a seven-year-old association promoting the model, estimates 5,000 doctors are in concierge medicine nationwide.
No one tracks data on concierge doctors in the Washington area. John Richards, executive director of the Medical Society of Northern Virginia, says the model got attention here a few years ago and estimates that there are now a couple of hundred concierge practitioners areawide.
MDVIP, a national concierge company that opened in 2000, counts Washington as one of its best markets. More than 30 of its 330-plus doctors work in the area; many of the physicians closed up traditional practices and reopened under the MDVIP banner. Their patients typically received a letter and an offer to help them find a new doctor if they didn’t enroll in the new practice.
There’s nothing radical about the idea that profit can be made from an enhanced patient/doctor relationship. More than 60 years ago, the Greenbrier in West Virginia opened an “executive health” clinic with extensive physicals, preventive screening, and a bit of pampering. Johns Hopkins and the Mayo and Cleveland clinics have similar programs that are the gold standard today, offering everything from electrocardiograms to a complete blood chemistry. Such programs operate locally, including at Inova Fairfax Hospital and Virginia Hospital Center.
Executive physicals, however, tend to be one-shot deals: You meet with a doctor, undergo a battery of tests, then return to the care of your regular physician. Concierge care typically offers a version of that physical, but the physician conducting the tests becomes your doctor.
PartnerMD was founded by Richmond entrepreneur Linda Nash. Like Al Newland, Nash had a beef with her doctor. In Montana on vacation, she was thrown from a horse and taken to the hospital. Her husband and the hospital tried repeatedly to reach her family physician in Virginia. “A doctor’s staff can be as dogged as gatekeepers,” Nash says. “It’s all about keeping consumers away to maximize the physician’s time.”
From that experience, Nash saw a business opportunity. In 2003, she opened PartnerMD with one doctor and about 40 patients. The practice has grown to 3,500 patients and nine doctors, and the company projects 10-percent growth in revenues in 2009.
PartnerMD patients pay $1,900 a year in membership fees, with a $1,500 charge for spouses and $600 per child. Otherwise, the company’s practices operate very much like traditional fee-for-service doctors, negotiating rates with insurance companies and charging patients accordingly. Membership includes an annual physical, but patients still pay deductibles and copays.
Nearly two years ago, PartnerMD expanded to McLean, aiming to tap business executives in the Tysons Corner area and families with two harried professionals.
PartnerMD’s offices on the seventh floor of a downtown McLean building are well appointed but not lavish. During several visits, the waiting room often was empty, devoid of disgruntled people whose appointments were scheduled to have started an hour ago.
To open the office, PartnerMD hired Sandy Ibrahim, a young family doctor married to a Comcast engineer. The daughter of Egyptian immigrants, Ibrahim, 35, studied microbiology at the University of Michigan in her hometown of Ann Arbor, then went to Wayne State University’s medical school, one of the biggest producers of primary-care doctors in the country. She never considered any specialty but family medicine.
“I wanted continuity with the patient, to grow with them and become part of their family,” she says.
After finishing her residency in 2003, Ibrahim joined a practice in Fairfax, then another in McLean, but found neither satisfying. She raced through appointments and left work too exhausted to care for her two young children. As one of the younger doctors in both practices, she was expected to make room in her schedule for fevers, sore throats, stubbed toes, and other same-day emergencies.