From the
Washington Business JournalCare is Deluxe at Clinic that Caters to Affluent
By Carolyn Hirschman
You get what you pay for, the old adage goes. Many of us drive compact cars; a few cruise around in Mercedes Benzes. The same holds true in health care, as shown by a clinic in Chevy Chase, Md., that caters to wealthy executives.
A $10 co-payment gets most workaday drones five or 10 minutes with a doctor who’s too busy. But for $3,000 to $5,000 per year, top executives can have the ear of Dr. Timothy T. Soncrant for hours on end.
Most people pay for medical care through health insurers, often managed-care providers. But almost all of Soncrant's patients pay out of pocket. They are part of the only 18 percent of health-care expenditures in the United States self-paid in 1995, the latest figures.
"The clinic is in the right place at the right time," said Robert Davis, executive director of the Maryland Health Care Coalition, an employer group. It could succeed because of the backlash against managed care coupled with the Washington area’s relative affluence, he said.
"Health is the one thing that people want and will buy, and price is not an issue," added John Menefee, a senior health care consultant at Watson Wyatt Worldwide.
Catching it early
The Drew Clinic, named for Soncrant’s sons David and Andrew, specializes in the early detection of disease. The goal of its diagnostic services is to catch cancer, heart disease and other conditions early enough so they can be nipped in the bud, preventing full-blown and potentially life-threatening conditions that are expensive to treat.
"Traditional medicine is based primarily on the premise of treating symptoms," said Soncrant, an internist who formerly headed the Institute on Aging’s clinical treatment program at NIH. "Quite often, when patients wait for symptoms to signal the presence of life-threatening ailments, the disease is often advanced beyond the curable stage."
The concept of prevention is well-understood -- but not always well-practiced -- in an industry dominated by managed care, a type of health insurance that restricts coverage to certain services and steers patients to certain physicians to save money.
Managed care typically covers routine screenings, including mammograms to detect breast cancer, Pap smears to detect cervical cancer, and tests for lung, prostate and colorectal cancers in certain age groups.
All the tests
In contrast, the Drew Clinic offers every imaginable test, including new genetic tests for predisposition for breast cancer and screenings for less common brain, stomach and ovarian cancers. There’s also cardiac assessment, comprehensive imaging and lifestyle counseling.
Insurance doesn’t normally cover these services because their high cost doesn’t merit the benefit of catching the relatively few people who have rarer diseases, said Susan Rucker, a partner with KPMG Peat Marwick in Baltimore.
"I’m trying to bring technology that’s not conventionally applied in the clinical realm," Soncrant said. Patients usually pay what private insurers and Medicare pay for each test, he said.
Soncrant performs evaluations, medical histories and some lab work in an elegant, 2,300-square-foot penthouse office. Other testing is done by providers in the same building at 5454 Wisconsin Ave.
Footing the bill
Who pays for all this? The clinic’s target population is wealthy individuals and corporate executives in their late 30s and older with household incomes of at least $200,000. Some patients pay their own bills. Some employers pick up the tab -- a common perk for top executives.
The Mayo Clinic in Rochester, Minn., the Cleveland Clinic and Johns Hopkins University in Baltimore all offer corporate wellness programs.
Some patients come to the Drew Clinic with particular needs, say, to test for diabetes. The "regulars" are entitled to a full health evaluation and a one-year program of two visits and tests.
Soncrant said he’s not trying to perpetuate a society of medical "haves" vs. "have-nots."
"It’s out of the range of some people now, but it depends on how you want to spend your disposable income," he said.
Despite its high price tag, the Drew Clinic will succeed, health care analysts predict. It doesn’t need managed care because some people are willing to pay more to get more.
"Folks with money have always opted out of standard treatments," said Davis. For example, plastic surgery is rarely covered by insurance, yet plastic surgeons have plenty of business. In the case of the Drew Clinic and its emphasis on prevention, patients are buying "peace of mind," added Rucker.
The clinic’s self-pay approach is also a reaction to managed care, analysts said. Instead of "wait-your-turn" delivery where actual doctors barely pop their heads in the door, rich patients get the luxury of quick access and an M.D.’s personal attention -- a throwback to what family doctors used to do.
