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Imagine no waiting rooms because most patients do not need to wait.
No managed care discounts and no insurance claims to file.
Physicians who linger with their patients for an hour or more, discussing test results, risk factors and health goals.
Influential decision-makers returning to their workplace to tell their benefits department, “Make sure that hospital is in our network.”
It’s not a dream; it’s executive health programs—a small oasis in the turbulent waters of the hospital industry. As demand for individualized attention grows, hospitals that offer these programs are finding profits in preventive medicine.
“The first year we saw 34 patients, and this year we’ll be seeing about 225,” says Sarah Kabat, program director of the five-year-old University of Colorado Hospital Executive Health program at the Anschutz Medical Campus in Aurora.
“We’ve tripled the volume in the last five years,” says Marianne Gibbons, director of executive health services at Massachusetts General Hospital in Boston, which expects to serve about 900 patients this year.
“We’ve seen at least 10 percent growth over the past three, probably four years,” says Reid Willingham, administrator of Emory Executive Health in Atlanta, which has been offering executive health services for more than 20 years.
Executive health programs—which are not just for executives, but more on that later—offer a comprehensive physical examination, including laboratory testing, in a single session that lasts just a few hours. Although the array of services varies from one program to the next, they all offer two luxuries in today’s healthcare world: efficient use of time and a long visit with a physician.
“Most of our executives want to get here and get their physical done in a half day and be gone,” says Willingham, rattling off a list of services that would require several separate appointments in the normal healthcare system. Emory’s program will see nearly 1,100 patients in 2007.
Face time with the physician is the other big drawing card.
“Our patients spend up to two hours with the internist, going over the results, talking about the big picture and creating the optimal plan for their health from that day forward,” says the University of Colorado’s Kabat. “That is often a deciding factor when people choose executive health programs. It’s very hard to provide that in the current settings that insurance dictate.”
Ah, insurance. It’s what executive health providers—and their patients—don’t want to deal with. By its very nature, insurance reimbursement motivates providers to speed up each appointment, offsetting the low per-patient rate with a higher volume of patients. That’s the treadmill that executive health programs jump off.
“People have craved a different sort of experience,” says Eric Hegedus, a doctor of physical therapy who participates in one component of the Duke Executive Health Program in Durham, NC. “People are willing to pay for individualized care and individualized wellness.”
At Mass General—which, thanks to a satisfied patient who donated money, built a dedicated suite for its program four years ago—patients pay $1,400 to $1,600, depending on their age, for a core physical that lasts about two hours. Emory Executive Health typically charges $1,300 to $2,200, depending on the specific services the patient chooses, plus more for a colonoscopy. The University of Colorado Hospital program costs $2,685 for men and $2,850 for women.
Each of those programs is profitable, but the annual contribution to the bottom line is just one of the benefits to the hospital. The downstream revenues are what really count.
“Emory gets referrals with people who have very good insurance, and that helps all of Emory,” Willingham says. “And we found that, if the top people in the company come in—the CEO and the vice president of HR—when they are reviewing their insurance contracts for the next year, they’re going to make sure that Emory is in network.”
Mass General, which began offering executive physicals a decade ago, sees executive physicals as an opportunity to build relationships with individuals, Gibbons says. “There may be additional procedures or care that people are going to need in the future, and they might consider Mass General because they’ve had a good experience,” she says. “Ideally they may become friends of the hospital in the future.”
Many—in some programs, the vast majority of—executive health services are paid for by employers. Some companies view the service as “asset protection” to make sure their highly paid leaders are healthy and productive; others offer an executive physical as a benefit to their top managers.
Richard Abrams, MD, founder of the Rose Center for Preventive Medicine at Denver’s Rose Medical Center, stopped using the term “executive health” when he recognized the broad spectrum of people willing to pay for the services. “One of the big surprises to me was when people started coming who weren’t executives and who weren’t wealthy at all, but who valued a proactive approach to health enough to be willing to pay for it themselves,” he says.
When he started the program five years ago, most patients were men. His program costs $2,800 and includes a 64-slice CT scan, a 2.5-hour physician consultation, physical exam and advanced lab testing as part of the five-hour appointment. Because so much information is discussed, he started inviting, with a patient’s permission, a spouse to sit in on the discussion.
“Invariably at the end of the session, the spouse would say, ‘Gee, shouldn’t I have this too?’” he says.
Today, about 50 percent of Rose Center patients are women, and the majority of patients are self-pay, rather than employer-paid.
Lola Butcher is a Springfield, Mo.-based freelance writer and a frequent contributor to HealthLeaders magazine.
Work on That Slice
For most people, having a physical does not rank high on the fun meter. But if that health assessment involves practicing your golf swing on one of the nation’s top university golf courses while a physical therapist and a top-ranked golf teacher watch, fun might creep into it.
The Integrated Golf Experience is one of the add-on options of the Duke Executive Health program in Durham, NC. After completing the comprehensive assessment—a physical exam, laboratory tests, chest X-ray, body fat assessment and more—the patient moves to the exclusive Washington Duke Inn and Golf Club for further testing.
There, Eric Hegedus, doctor of physical therapy at Duke, analyzes the golfer’s strength, motion and balance while Ed Ibarguen, PGA master golf professional at the club and one of Golf Magazine’s Top 100 Teachers in America, puts a stethoscope to the patient’s swing. Golf instruction follows.
“If you have an executive who happens to also be a golfer, it fits beautifully because they get physical therapy and a fitness consult with regard to their golf game,” Hegedus says. “For some people, that seems to be the motivating factor to get a physical—the fact that their golf game is suffering.”
An assistant professor at Duke, Hegedus started the program in conjunction with the medical center as a way of capitalizing on its reputation and name recognition. That has worked well, and the program is beginning to repay the favor.
“It’s begun attracting people to Duke who might not otherwise come to Duke,” he says.
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