During the Vikings season from August to January, team physician Joel Boyd gets a call from one of the trainers on a daily basis, sometimes two or three times a day. By the end of the afternoon, if the injury is concerning, the player will be in his office—the same office where Boyd sees 50 patients each week, from arthritis sufferers to high-school athletes. And even though he says he treats all his patients the same, that a knee is a knee, there are a few key differences in what happens next.
Compared to an average injured Joe, the average Joe Mauer is likelier to get pricey MRIs to assess the damage, for example, followed by hours of intensive rehab using water treadmills and other specialized gear. If the athlete isn’t recovering as quickly as he’d like, he may also pay thousands out-of-pocket for experimental treatments such as platelet-rich plasma therapy, which involves injecting a patient’s own centrifuged cells into the injury to stimulate healing. Although PRP has yet to be proven across-the-board in clinical trials, a growing number of athletes have tried it—including L.A. Lakers star Kobe Bryant (who traveled to Germany for the treatment and posted a picture of his knee being needled on Instagram) and 20 of Boyd’s patients from the Vikings, the Wild, and the Lynx.
Cutting-edge platelet-rich plasma therapy
Photo courtesy of American Association of Orthopedic Medicine
The needs of VIP patients such as pro athletes and business executives have increasingly become a driving force in the medical field. Not only does their ability to perform their jobs impact collective billions of dollars, but they (and their employers) have the financial resources to devote to high-cost experimental treatments and high-end services. At a moment when the Affordable Care Act has broadened access to a baseline level of medical care, a peek behind the examination-room door reveals that an improved standard of care for the masses may come from an unlikely place: the trickle-down effect of care for the 1 percent.
Compared to an ordinary annual exam, an executive health physical is the health-care equivalent of flying via private jet instead of commercial coach. At the Mayo Clinic, such exams begin with a conversation about family history, sleep, exercise, and other issues that help tailor the tests and specialist appointments that will ensue over the next full day or two—a stark contrast to the 15 to 45 minutes many people spend with their general practitioners during a checkup. For busy C-suiters, combining blood work, stress tests, hearing, and vision exams with other appointments into one clinic visit is the only way it’ll ever get done (with the added perk of private offices for important calls so patients can conduct business during their appointments).
“My schedule fills up a year in advance,” says Michael*, an executive at a biopharmaceutical company who has been getting this kind of comprehensive health workup from a variety of institutions over the past 25 years, including the Mayo Clinic. “For someone like me who’s traveling all the time or working 12 hours a day, having all of that happen in a focused and concentrated fashion is very helpful. You put in on the schedule for next October, and then you actually do it.”
Besides the condensed nature of the experience, the executive program offers access to world-class specialists who give immediate attention to health issues that emerge, using the state-of-the-art technologies Mayo has on tap. Kurt Carlson, director of the Rochester program, offers as an example the recent experience of a 50-something Twin Cities executive who arrived for what he thought was going to be a routine physical. When blood tests at the beginning of the day revealed severe abnormalities, the patient was diverted immediately to a hematologist, who started him on an urgent course of leukemia treatment before he left the clinic.
“We make a tremendous effort to try to address any newly identified issue in the same setting rather than making a patient wait one to two months to deal with it at a future date back home,” Carlson says.
This kind of service comes at a cost, ranging from $3,600 to $9,200. Last year, more than 12,000 patients from around the world came through Mayo’s program. That’s twice the number who participated in 2011. Like pro athletes, top execs can be worth millions to their employers, and executive health physicals are seen as an important way for corporations to protect their leaders from heart attacks and other debilitating or fatal conditions, especially when those leaders are notorious for neglecting sleep, exercise, and doctors’ appointments while pushing the limits of stress.
So would everyone benefit from a $5,000 work over? A regular, thorough examination can certainly speed the discovery and treatment of health issues, says Michael, who has been diagnosed with three different kinds of cancer over the past 25 years. But there are downsides to excessive screening, according to growing evidence that questions the regular use of screening methods such as mammograms and prostate-cancer tests.
“I’m tired of the sleepless nights around the false positives,” says Linda*, a patient in the program who receives executive health benefits as the spouse of an executive at a Twin Cities–based multinational corporation. She goes to the Mayo each year with mixed feelings. One extensive checkup revealed the beginnings of heart disease—a welcome wake-up call. On the other hand, several times she’s felt that she experienced unnecessary suffering as a result of alarms raised by unusual test results that turned out to be nothing more serious than naturally lumpy breasts.
“I feel like I’ve got to do it because it would be irresponsible not to take care of my health,” Linda says. “But I’m 54 and when you start looking for disease, you’re going to find it or you’re going to find false positives or symptoms. It can be scary.”
The Mayo’s focus is on evidence-based prevention, Carlson says, considering the latest research before determining which tests each patient needs based on individual risk factors. The program also emphasizes stress-related health issues, ensuring each patient visits with a preventive cardiologist (to advise on heart-healthy behaviors) and offering resiliency training (to help with stress, decision-making, and cultivating a flexible disposition) as an add-on—services that aren’t unattainable to those outside the executive program, but ones that the average patient would have to make an effort to seek out. Nevertheless, plenty of patients regularly ask for next-generation tests, such as genome sequencing for markers of disease risk—tests that generally produce an abundance of information that doctors still have little to no idea how to interpret. “We have patients coming in and saying, ‘I want to have it done, and I don’t care what it costs,’” Carlson says. How to counsel those patients on a course of action is something his team is still working on.
Mayo Clinic performed some 12,000 executive health physicals last year
Photo courtesy of The Mayo Clinic
Despite the elite nature of VIP medical care and the criticisms that come with it, it has indirectly resulted in benefits for everyone. Mayo doctors incorporate many of their treatment findings from executive patients into research studies, which can end up altering recommendations throughout the medical community. The same is true for athletes who try experimental treatments on their own dime, Boyd says. Their willingness to pay for unproven protocols can build enough anecdotal evidence to eventually spark research studies that allow treatments to become more attainable to spectators on the sidelines.
Through their work with athletes, Boyd says, physicians have developed protocols for the safe use of cortisone injections in patients and they’ve found that outcomes are better when rehab starts the day after ACL-reconstruction surgery instead of waiting a few weeks. Some athletes are now using artificial joint lubricants called viscosupplements, which have also been shown to help people with degenerative arthritis. PRP and stem-cell treatments may be next, some day used in clinics on a regular basis much like other prescription anti-inflammatories. “We translate what we do in sports to our everyday practices fairly regularly,” Boyd says. “Somebody has to pave the way.”
For an annual fee of up to $25,000 or more that is not covered by insurance, the Seattle-originated medical practice MD² offers unlimited around-the-clock medical access to a doctor who cares for no more than 50 families (instead of the typical 2,500 patients cared for by most internists), makes house calls, and accompanies patients to hospital visits, among other perks. The company now has offices in eight cities, none of them in Minnesota. (Also not available here: doctors for the stars who charge retainer fees of up to $30,000 a month.)
Instead, a growing number of physicians in Minnesota and elsewhere are offering concierge-style care that’s affordable to a wider range of patients. It’s an example of how a model that started as part of 1-percent care—a patient-centered experience that’s more comprehensive, personalized, prevention-focused, and comfortable—is becoming accessible at a much lower price.
Dr. Jacob Liston used to scramble to get through a slate of 20 patients each day. There was never enough time to offer advice about healthy lifestyle choices, and he was drowning in the paperwork required to seek reimbursements from insurance companies. “Everything I thought being a doctor was all about when I was in medical school got pushed to the wayside,” he says. “It felt like I was on a treadmill.”
Last year, Liston and his colleagues at Southdale Internal Medicine in Edina switched to a cash-only practice. The move dramatically reduced their overhead, allowing doctors to see fewer patients, spend more time with each, and, perhaps counterintuitively, charge less. Patients now pay directly for what they get: $25 for a strep test, $30 for an EKG, $5 for a fungus exam, and up to $250 for a comprehensive physical. No insurance is allowed, though most patients keep high-deductible plans to cover specialist appointments and hospital visits. The clinic also offers extras. For $300 a year, patients can get access to their physician’s email address and cell-phone number. An annual fee of $2,500 covers all office visits, lab tests, and other procedures performed on-site.
During a recent annual physical, Liston chatted with 44-year-old Natalie Hagemo for nearly 45 minutes about her thyroid, quality of sleep, drinking and eating habits, concerns about her hearing, and lack of scientific evidence to support an over-the-counter herbal supplement she was taking. They also talked about her family and her work as a columnist, blogger, and radio host. “In the past,” she says, “if I went in for a sore throat but also had a question about my foot, I wasn’t allowed to talk about that, because that’s not what I was there for and that’s not how insurance is billed.”
There is obvious appeal to this model for patients, and doctors say they benefit, too. “I get to dig in,” Liston says, “ask more questions, guide patients to healthier paths, and have time to think about their problems.”
To be sustainable, changing models of care must ultimately help practitioners as well as patients. And if these innovations can demonstrate real, long-term benefits, recent medical history suggests that they will then spread from the few to the many. Sooner or later, you could have the same knee treatment as Kobe Bryant—even if you don’t arrive at the clinic in your private helicopter.
* Names changed for privacy.
EXCLUSIVE: Web Extra Photos
Photo by David Sherman
Photo by David Sherman
Photo by TJ Turner