Some Reston-area residents are taking part in an increasing health care trend: primary care physicians who are changing their practices to "concierge" practices.
Concierge medical practices charge a membership fee to join – which critics say makes them "too exclusive" for the average patient. However, in return, concierge doctors conduct more extensive annual physicals and testing, offer "assured appointments," detailed lab results, health risk analysis, and assessment of long-term wellness goals.
One Reston physician who has made the switch is Dr. Kevin Kelleher. Kelleher, with business partner Dr. Mark Vasiliadis, founded Executive Healthcare Services in 2004, leaving their traditional practice, Generations Family Practice, located next door.
Kelleher and Vasiliadis still own and operate Generations, but see only patients at Executive Healthcare.
Vasiliadis first heard about concierge medicine in 2001 from MD², the first concierge practice in the US, started in Seattle in 1996.
Vasiliadis' and Kelleher's family practice, Generations, had been growing very well, but they "were very busy, hurried, seeing 25 to 30 patients a day," Kelleher says.
The doctors said they were stretching to see patients earlier in the morning and later in the evening.
"We weren't able to implement fully the primary care aspects of medicine that we wanted to," Kelleher said.
They concluded that concierge medicine was a better model for family care. They could be stronger advocates for patients as their personal physicians.
"I know the people in my care," Dr. Kelleher said. "I have the time to implement the health improvement steps we have outlined, and early detection is better."
Kelleher's patients get 24-hour access to their physicians through e-mail, cell phones, pagers, and they always have a doctor on call. The doctors also make house calls, if requested. There are small perks, too, like snacks in the waiting room. An Executive Physical can take two-hours, and is more comprehensive than most physicals, says Kelleher.
Kelleher says the practice has established a relationship with specialists, offering them "the complete picture of a patient's health," and all related laboratory work and data.
Still, Kelleher acknowledges not everyone can afford concierge care.
The fees at Executive Healthcare, which are in addition to any monthly health insurance costs, start with the Initiation (and first month's) fee of $1500 (for individuals or families). Individuals then pay $250 monthly, while the first adult of a family pays $250/month; the spouse, $200/month; and any children, $50/month. Families with college-age students (18 to 25 years) can pay $150/month for their coverage.
Corporate members, meanwhile, pay $3100 annually, which includes their Executive Physical.
For any patient, office or in-house testing visits are extra, starting at $60/visit. For insurance, the practice is considered an out-of-network provider. Most of their patients do keep their health insurance and get reimbursed for some of the office visit costs.
Executive Healthcare limits the practice to about 300 patients per doctor to be able to focus on those patients. At a traditional practice, it is about 1,000 patients per doctor.
Kelleher says he has a 98 percent patient retention rate. "Patients rarely leave our practice," he said, "and if they do, they come back."
Tom and Marion Rametta, who lived in Reston for 30 years before moving to Dumfries a few years ago, have been under Dr. Kelleher's care for 25 years and said they easily made the switch to the concierge practice.
"It is fabulous," Mrs. Rametta said. "We feel very specially cared for. It makes medicine so different." They rarely see other patients in the waiting room, and they don't wait long to see Dr. Kelleher."
Meanwhile, Inova recently began a concierge medical program.
Dr. Craig Cheifetz, medical director of the Inova VIP 360 program, thinks it is "the ideal practice – it is what every patient wants."
Cheifetz also emphasized the low patient-to-doctor ratio. He says their program has about 200 patients per doctor, while the average internal medical doctor has 3,000 to 4,000 patients.
He echoed Kelleher's assessment that concierge medicine allows doctors to effectively care for and teach their patients, given more time for office visits. "We see outstanding results and they know how to implement the health plans we have developed together," he noted.
At the Inova VIP 360 program, there is reserved parking, on-site lab work and a fitness consultations. The annual cost for Inova Fairfax's program is $1,800 per person.
Concierge care comes at a price to non-concierge patients, said Arthur Caplan, Ph.D, Director at the University of Pennsylvania Center for Bioethics.
"I think there is a move toward concierge care, no doubt about that, but it is not going to become a tidal wave," said Caplan. "The costs involved are not something that most Americans can carry, or even want to carry. Most people in this economic climate don't have the money to spend three, four, five thousand dollars or more to retain a concierge physician [in addition to paying for insurance costs]. So it is an upperclass phenomenon, in my view."
Caplan sees the trend as negative for patient care for most Americans.
"The downside of concierge medicine is that for every doctor who goes into concierge medicine, it means fewer primary care physicians for the rest of the population, and there weren't that many to begin with," he said.
Caplan also cautioned against assuming that concierge doctors are superior."There is no evidence that doctors attracted to concierge practices are better physicians," he said. "It may mean a faster response from a doctor, less waiting time, etc., but it does not mean the best doctors are going there – that is just a marketing implication of the term concierge."
