From
The Washington PostA Health Clinic Rich in Care
By Kathleen Day
A medical clinic in Chevy Chase has an unusual prescription for annual checkups: An interview with a doctor that lasts several hours, ultrasound scans of all major organs, and genetic screening to determine a patient’s inherited susceptibility to such diseases as cancer and Alzheimer’s.
The clinic even has revived the all-but-moribund house call.
Yet the services of the David Drew Clinic, extensive as they are, are much more expensive than the yearly physical exams allowed under most health care plans. As such, they are being targeted to affluent patients who can afford comprehensive, forward-looking care and the extra touches that accompany it.
Health-care analysts and executives said the clinic illustrates a growing demand for specialty medical services from those willing to spend more than managed-care companies, with their limits on services and on access to expensive procedures, are willing to pay for. To satisfy this demand, such providers are going upscale, offering specialized medical services in elegant surroundings to well-heeled patients. High-technology screening, including genetic testing, is often a focus as patients hunger for information about their long-term health.
Such renowned medical institutions as the Cleveland Clinic and Mayo Clinic for decades have offered such specialty screenings, often used by business executives, but say that in the past two years they have received inquiries from medical groups across the country interested in replicating that model.
The Drew Clinic’s clients primarily are individuals and business executives ages 40 to 65 who are willing to spend several thousand dollars a year on sophisticated screening to detect medical problems or susceptibilities before symptoms appear.
Doctors say spotting diseases early often makes them easier and cheaper to treat, but most managed-care providers won’t pay for this screening, arguing the few cases caught don’t merit the extra cost the tests entail. Some patients want to determine their susceptibility to diseases for which there currently is no treatment, such as Alzheimer’s, so they can try to limit their chances of getting the disease or take advantage of treatments when they become available.
"We’re seeing the beginning of a trend where most people get basic care and people with deep pockets pay cash to buy something that isn’t available under conventional health insurance – it could be a choice of super-specialists or preventive care for what I’d call the ‘worried rich’," said Drew Altman, president of the Kaiser Family Foundation in Menlo Park, Calif., a nonprofit health-care research group.
Access to health care always has been uneven, with poor people receiving the least amount of care, middle-class people receiving standard care and rich people paying for extra care, said Ken Abramowitz, a health-care analyst for Sanford C. Bernstein & Co. But with technological advances developing ever more sensitive ways to predict and prevent disease, the differences will become more pronounced, he said.
"People have a right to worry about their health," he said. "But right now, it’s people who are curious and have money who will benefit the most, the soonest. But since when is that different from anything else in life?"
David Drew Clinic’s founder, Timothy T. Soncrant, a physician specializing in aging, makes no secret that they chose to locate in the Washington region in part because it has one of the nation’s highest median household incomes.
The 1,800 engraved invitations the clinic sent to potential clients read in elegant script: "You are cordially invited to participate in a revolutionary, technologically advanced health program that detects heart disease, impending stroke and cancers before catastrophic illness occurs."
Housed in an office building near the Friendship Heights Metro station, the clinic is furnished with Chippendale-style furniture and has framed reproductions of impressionist paintings on the walls. Classical music plays softly through speakers in every room. Coffee table books include one on Monet and another titled "Villas and Gardens of Tuscany." No copies of People magazine are in sight.
Soncrant said they aren’t adding bells and whistles to health care, but providing hard-core benefits. The clinic, they said, is part of a growing recognition in medicine that preventive care saves lives in the long run.
"Under traditional health care, you come to a doctor when you are sick or have symptoms of a disease," said Soncrant, who worked for 10 years at the National Institutes of Health in Bethesda, founding and running the NIH Institute on Aging’s Clinical Treatment Program. "Our approach is to find people before they have symptoms. The idea is that the sooner you find something, the better you can treat it."
He said, for example, that if kidney cancer is found before it spreads to other organs, the cure rate is 80 percent. After it has spread, the cure rate drops to 20 percent. Typically, physicians find such cancer before it spreads only 40 percent of the time. Those are grim odds for a patient, but insurers contend that performing this level of screening for all patients would be too expensive, raising medical costs significantly for the benefit of a few.
Soncrant said he believes that the clinic’s fees aren’t just affordable for the rich, but also are within reach of many middle-income families, who might forgo an expensive vacation or new car in favor of exhaustive medical screening.
"This is something that’s needed in terms of the people wanting to take a more proactive role in their health care."
The practice Soncrant envisions is an outgrowth of exhaustive annual physical exams that some companies offer to their top executives at such institutions as the Mayo Clinic in Rochester, Minn., and the Cleveland Clinic. Both clinics said interest in their programs have been growing in recent years, though they don’t offer genetic testing.
"Companies have a lot of money invested in their people. It’s in their interest to stay on top of the health of these people," said Richard Lang, head of preventive medicine for the Cleveland Clinic. "As managed care has come more into play, people are willing to look outside their plans to get quality, thorough medical care with good screening and good preventive care."
"The advantage is that we can spend time with a patient discussing at length, unlike an HMO, where doctors spend 15 minutes at the max," said Donald Hensrud, director of the executive health program at the Mayo Clinic.
Dames & Moore Inc., a Los Angeles engineering and environmental consulting firm, finds this service valuable and pays for screening at Mayo and Cleveland Clinic for about 100 executives, out of its work force of 5,500.
"The selfish aspect of the company is to make sure people stay in good health, to be proactive rather than reactive," said Joe Udwari, vice president of the company’s Bethesda office.
Soncrant and others said that although managed-care companies maintain they emphasize preventive care, they can't afford to provide much screening. Soncrant believes the success of clinics that require higher out-of-pocket payments rests with better care.
"We begin with the question: What can we do to find things before they happen?" Soncrant said.
