For sale: body scans, boutique care & second opinions - Retail Health Care

Physician Executive, March-April, 2003 by David Ollier Weber

AmeriScan's motto is "Every two years." Founded by radiologist Craig A. Bittner, MD, it has four locations, three near its Scottsdale, Ariz., headquarters. But there is hardly a major city that does not have at least one radiology practice touting the benefits of voluntary CT screening of the entire body or particular parts such as the colon, coronary artery system or lungs.

The cost of a scan can run from $750 to $1,600, and the patient-or in some cases an employer-foots the bill. A few clinics are reportedly netting more than $2 million a year. But many doctors-not to mention the American College of Radiology, the American College of Cardiology and the U.S. Food & Drug Administration-seriously question the value of the procedures.

Riddick is one critic. He sees basic problems inherent in marketing to the public a screening of such high sensitivity but low specificity.

"My ethical difficulty with it," he says, "is this: How much informed consent is involved when the patient forks over $900? Do people who self-refer really understand what they're buying?"

AmeriScan describes its service as "the perfect life-changing gift." That's an understatement. Riddick notes that in one study of full-body CT screening, fully half of the first 900 patients showed an anomaly that required a follow-up, "and a lot proved to have no disease."

Aside from the expense to the health care system of ruling out false positives, the patients and their families were subjected to a dreadful bout of worry and the very real dangers associated with more aggressive diagnostic interventions. They also get a dose of radiation 100 times stronger than a simple chest X-ray. And then there's the issue of misplaced confidence inspired by a false negative.

Physical fitne$$

Ironically, for many of these medical retailers the Holy Grail is coverage by a health insurer, or at least by a large-scale health care purchaser.

The Cooper Clinic in Dallas pitches its comprehensive six- to eight-hour physicals--which cost $1,800 to $4,000 and include an electron beam tomography scan--as an executive perk for corporate clients. While at Cooper, patients can stay at a gracious Cooper-owned 62 bed lodge, work out or get a massage and facial at the deluxe Cooper spa and go home with a bagful of Cooper-recommended Cooper-label vitamins and dietary supplements.

Health insurers often cover second opinions for major diagnoses, but insurers have been wary of paying for virtual consultations. Which is interesting, since the cost of the latter is a fraction of the bill for a visit to a prestigious hospital or clinic, points out the e-Cleveland Clinic's executive director C. Martin Harris, MD, MBA.

"I believe as we build credibility we can take this model to the payer market," agrees Joseph Kvedar, MD, Partners' director of telemedicine.

Many physicians, though, are utterly disillusioned about the boons bestowed by insurers. In the vanguard are those who have chosen practice retainers or membership fees.

At the forefront of this widely publicized mini-trend is MD2, of Seattle. Since 1996, internists Howard Maron, MD, and Scott Hall, MD, have charged $13,200 a year ($20,000 for couples) to a select group of about 100 patients and families who are promised 24/7/365 access to doctoring at home or in an office featuring marble halls, antique furnishings and monogrammed robes. MD2 wants to franchise the concept as well, for a $75,000 fee to set up a similar two-doctor office.