Click the following titles to read the full article:

The doctors will see you now - David Whitford, FORTUNE
PartnerMD: a medical model for long-life and vitality - Cindi Graesser
For patients with little patience for waiting - Melanie Mayhew

The doctors will see you now
How does a high-priced 'executive physical' compare to your average HMO doc? The visit could change your life, as David Whitford found out.

by David Whitford, FORTUNE Magazine, Fortune Small Business, and CNNMoney.com
June 21, 2006: 12:25 PM EDT

(FORTUNE Magazine) - A bowl of broth--that was lunch the day I arrived in Richmond. For dinner, two bottles of lemon-flavored Fleet Phospho-soda and four bisacodyl tablets. You see where this is heading? I went to bed on an emptying stomach, slept fitfully, and woke feeling weak and lightheaded. By 7:30 A.M. I was in a hospital johnny, supine, my chest festooned with electrodes, my lower alimentary canal inflated like a balloon, as a gurney fed me headfirst into a $2 million GE-Imatron electron-beam tomography (EBT) scanner. Miserable and scared, in other words, and that was before I saw my test results.

PartnerMD, the party responsible for my suffering, is one of those new concierge medical clinics that cater to patients who are sick of HMOs and can afford better. For a $1,700 annual fee plus the cost of care ("not a whole lot more expensive than premium cable," says PartnerMD CEO Linda Nash, not quite persuasively), you get appointments that begin as scheduled, ample face time with a doctor, and a holistic approach to medicine that emphasizes screening and prevention over disease management-- and even house calls "when medically necessary." If the concept appeals but you can't find a clinic in your town, then for about $4,000, depending on which tests you choose, you can have a PartnerMD executive physical, as I did, and at least get a taste of the concierge treatment.

Following my EBT scan, I pulled up my pants and staggered down the hallway to get my blood work done, after which, mercifully, nurse Amy showed me to my private office--outfitted with a swivel chair, Internet access, and a radio pretuned to Lite 98 FM--where I feasted on nutty snacks and checked my e-mail. The actual physical exam, performed by Amy and my doctor for the day, Jim Mumper, lasted a full hour. That kind of schedule works only because each PartnerMD physician has no more than 600 patients, compared with 3,000 or so for the average GP.

Dr. Mumper joined me at noon to dine on roast pork and spinach salad while we discussed what brings executives to the doctor's office. "It's what you would expect," Mumper says. "Insomnia, sleep disturbances, chronic abdominal pain from irritable bowel syndrome, headaches, fatigue. The body doesn't like stress."

The afternoon passed in a whirlwind of subappointments: an hour of strength and fitness testing with Rose (64 overall on a scale of 100; it seems I'm not very flexible); a stress-management consultation with Sherry (among the findings: "Mr. Whitford has lots of things to do, and he cannot change that."); nutrition counseling with Valerie; and the highlight of my day, a one-hour massage with Melissa. "You can turn over now, David," Melissa whispered in my ear at the halfway point. I was naked under a towel. The lights were dim. Soothing New Age music tinkled softly from the CD player in the corner. "Whatever you say, Melissa," I mumbled drowsily.

All in all, a wonderful day--except for the EBT scan and the story it told. EBTs are cutting-edge diagnostic tools that can detect tumors anywhere in the body and uncover hidden evidence of heart disease. The tests run about $400 and are usually not covered by insurance. According to Mumper, that's because too often EBTs reveal false positives, in which case you have to return for a follow-up scan. On the other hand, nearly everyone agrees that EBTs are very good at detecting coronary plaque, or atherosclerosis--especially in patients who seem perfectly fine.

I walk five miles every day, I'm not overweight, I haven't smoked cigarettes since college, and there are no scary diseases in my family history. Nevertheless, my EBT scan revealed a calcium score in my left anterior descending coronary artery-- the one that's nicknamed the "widow maker," because if it clogs, you can die--of 121.54. That would be a decent number for a 75-year-old (the range runs from zero to the low thousands), but I'm only 49. Eighty-five percent of men my age have a lower score. "It's good that we know," was Dr. Mumper's sober comment as he looked over my results. "That alone makes your trip down here worthwhile."

When I followed up back home with a stress test, doctors found no evidence of diminished circulation. I wish I could feel good about that. Unfortunately, the whole point of the calcium score is to measure the extent to which plaque has invaded the arterial wall before it causes tearing or blockage.

A widely cited study published in the journal Radiology in 2003 found a high correlation between "the extent of coronary calcium"--that's the calcium score--and "mortality risk." My number means that while my overall risk profile remains low, I'm four times more likely to drop dead within five years than someone with a calcium score under ten.

What am I to do with such knowledge? I immediately asked my brother-in-law Ron for his advice. "It's bullshit!" he said. That's typical of Ron, a heart doctor who eats and drinks what he pleases, knowing, he says, that disease relates principally to one's genes. (When pressed, Ron said I could drink more; drunks often have exceptionally clean arteries.)

Mumper was more sanguine. "We're going to come up with a drug in your lifetime that's going to make plaque go away," he promised. Until then, the best anyone can do is address other, more responsive cardiac-risk factors through diet, exercise, and medication. Long story short, I switched to oatmeal for breakfast; replaced red meat, white bread, and dairy with fish, whole wheat, and soy; swore off snacking at work; started swallowing multivitamins, fish-oil pills, and a daily low-dose aspirin; took up swimming twice a week at the Y; and stopped worrying about how much wine I was drinking.

As if by magic, I lost 15 pounds in three weeks. Two months later, I repeated the blood work. My LDL (bad cholesterol), formerly 176, was now 116; my HDL (good cholesterol) had risen from 66 to 80; and my total cholesterol had dropped from 266 to 211. That was still a tad high, given my risk profile, so my home doctor put me on statins, and when I followed up four months later my LDL was 54; HDL, 82; and total cholesterol, 145. "These readings are great," my doctor gushed.

Thanks to my fancy physical, I'm now aware of certain imperfections in my aging physical plant: probable calcification on the right lobe of my prostate gland; a heart murmur; atypical nevi (moles); tinea versicolor (skin fungus); and the two biggies, hyperlipidemia (high cholesterol) and atherosclerotic coronary artery disease. Knowing all that, I've taken reasonable steps to improve my odds. "Don't worry," says the other doctor in my family, Ron's daughter Henya. "Your blood pressure is fine, your good cholesterol is high, you'll be fine. And one day you'll probably die of heart disease, like most of us will." I guess I can live with that.

This story was adapted from an article in the June issue of Fortune Small Business.

PartnerMD: a medical model for long-life and vitality

By: Cindi Graesser
Owner and Publisher James River Publishing Inc.
Innsbrook Today Magazine
Short Pump Life
July 2003

I get a lot of press releases and fairly frequent phone calls from P.R. people pitching me stories for the magazine. This is a good thing (sorry, Martha). Editors love to keep the pipeline flowing with new information.

Sometimes there is a story that just begs to be covered, but it does not have an Innsbrook angle. This, I must have.

Such was the case with PartnerMD, a new, innovative, state-of-the-art medical model that provides the very latest in medical technology available anywhere and a doctor whose cell phone is on his office literature he gives to his clients. Of course I wanted to do the story, but I had to turn it down, I told Leslie Davis, a PR professional who pitched it to me. I needed an Innsbrook connection.

Not a problem, Leslie e-mailed me back almost immediately. Hilb, Rogal and Hamilton, headquartered in the Innsbrook Corporate Center, is an exclusive broker for PartnerMD. Done deal.

Leslie told me that PartnerMD was an innovative health care model that promises clients individual attention, same or next day appointments, half-hour minimum visits, and even housecalls, if necessary. PartnerMD offers its members, each of whom pay an annual fee, a doctor-patient relationship seldom seen since pre-HMO days. By limiting enrollment to just 600 patients (typical family practices have 3,000 – 5,000), Partner MD not only will make housecalls if needed, but offers a unique proactive approach to individual health, including annual physicals and ongoing monitoring of personal health goals.

James D. Mumper, MD, one of the area’s most respected family physicians, was recruited to join the PartnerMD team. “This new model of medical care allows me to do what I’ve always wanted to do- spend more time with my patients and give them the personalized service they deserve. With less patients and more time, I can get to know each and everyone personally and emphasize wellness (both emotional and physical), nutrition, exercise, and preventive medicine,” says Dr. Mumper.

PartnerMD also offers the only Executive Physical in Central Virginia according to Leslie. It is designed to rival the most respected programs in the country. It is considered one of the most thorough, accurate, and comprehensive health services available.

My interest was definitely piqued. I pitched Leslie back. Could I come in and go through the entire Executive Physical including the EBT scans (the only one of its kind in Virginia) and then write about it? –a first persona narrative taking the reader through the process of state-of-the-art health care? I received a call back saying PartnerMD founder Linda Nash, a local entrepreneurial businesswoman, would love for me to do such a story. They set me up my “schedule” and I was on my way.

After getting the go-ahead, things started to move along quickly. The office called to schedule my Executive Physical and I was told I would be mailed a packet of information and to please complete and return when I came in for my appointment. It was suggested that I wear comfortable clothing and not to eat or drink anything after midnight because of fasting blood work they would do.

I showed up in sweats the morning of my Executive Physical. The contemporary office and professional staff barely greeted me when Dr. Mumper came out and introduced himself. “How are you?” he said. “This is different,” I thought. I barely had time to select a magazine; forget reading it.

Dr. Mumper offered me a seat in his comfortable office and sat down next to me. He booted up his laptop setting on the coffee table and walked me through a brief overview of women’s health issues pointing out risk factors he is looking for during the complete evaluations. I did not know that 50% of all American women will die of heart disease. I would have thought breast or uterine cancer, but not so.

Dr. Mumper gave me a schedule for my full day for my Executive Physical. Following blood work, I would have a short breaktime for a snack and time to make phone calls; then I would complete a psychological questionnaire on the computer for the stress and anxiety assessments. I did this leisurely on the laptop set up in my rest area while I snacked on fresh fruit, a giant blueberry muffin and fresh coffee. Staff treated me royally, bringing me a second cup of coffee and asking, did I need anything else? Ok, I could get used to this. Following my snack, I met with Dr. Mumper to go over my complete medical history. Following a short break again to make phone calls, check messages (oh, the life of a busy editor), lunch was served for me and Dr. Mumper. When was the last time you had a leisurely lunch with your doctor to discuss, oh, whatever.

After lunch, I met with the psychologist who went over the results of my questionnaire. No surprises there- Type A personality; the doctor suggested I find a stress management activity, lean on other people once in awhile and consider further assessing or possibly treating with medicine his belief that I have Adult Attention Deficit Disorder. Now, that was a new one. That might answer the puzzle of my need for multiple, vertical filing on my desk. Hmmm...

After my session with the psychologist I went back in for my physical exam with Dr. Mumper. When he overheard his nurse say she was making me another pot of coffee and it would be ready in a minute, I was shocked to see Dr. Mumper return to the examination room after I had changed into a gown, bringing me a cup of coffee. Now, you don’t see that every day. His nurse had come in earlier to check blood pressure, temperature, weight, eyesight; she even measured my waist- now, that hurt.

My Executive Physical was a long way from over. It would also include advanced genetic testing (from blood drawn earlier), and a fitness assessment by one of only two professionally designated Professional Trainers in Virginia. A nutritional analysis would also be done as part of the comprehensive physical evaluation.

I was scheduled to return a few days later for my EBT scans at InterCardia Life Care Imaging down the hall from PartnerMD. Electron Beam Tomography or EBT is both the newest and most precise diagnostic technology available, according to InterCardia. It is the only scanner fast enough to accurately capture a picture of a beating heart. It involves no dyes, no needles and very little time. EBT has become the “gold standard” in coronary imaging and leading preventive cardiology programs, according to the literature. It looks inside your arteries. It measures the exact amount of calcified plaque in your coronary arteries.

For Dr. Mumper and other doctors who use the EBT, this technology enables the physician to assess the risk levels for a patient to have a future coronary event. As heart disease is the number one killer of both women and men, the EBT scan is important in making a patient aware of a potential coronary event before it occurs so that the patient and Dr. Mumper can work together to lower those risk factors and very likely the outcome.

With EBT, a person with a predisposition for a coronary heart event can discover his or her condition before it is too late to stop the event from happening. Often, medicines, lifestyle changes in diet, exercise and stress management can dramatically impact on a person’s longevity, Dr. Mumper explained.

Another aspect of the Executive Physical for women is the bone density scan. After my EBT scans, I was told to return to the office where I would be driven to Henrico Hospitals’ Medical Offices for a full body scan to determine bone density and total body mass breakdown: fat vs. muscle. I’ll report on the scans and the findings in next month’s issue.

I almost left out a very enjoyable part of the Executive Physical. The luxurious, one-hour massage following the fitness assessment was one of the best massages I have ever had. What a great way to end a busy, productive day.

So I had made it through two-thirds of my Executive Physical.

I left the office feeling exhilarated, knowing that I was participating truly in the medical treatment model of the future- using state of the art technology to help us take control over our health and risk factors in order to prevent disease as opposed to the old medical model of treating disease once it occurs.

My return appointment was scheduled in two weeks for my in-depth review of expert recommendations by two physicians and my Personal Health Plan for optimal vitality.

My next PartnerMD assignment? I had to do a little prep work over the weekend for my virtual colonoscopy set for the following Monday. I promise this report will be a real page-turner. Look in next month’s Innsbrook Today Magazine or go online to www.innsbrooktoday.com for updates as I make my way through the Executive Physical and begin the personal health plan to reduce my risk factors and hopefully live a longer life with vitality. I’ll share my risk factors and the tests’ findings and how the EBT scans nipped a couple of problems in the bud.

For patients with little patience for waiting PartnerMD finds customers are willing to pay more money for individualized health care

BY MELANIE MAYHEW
TIMES-DISPATCH STAFF WRITER
Feb 6, 2005

Sometimes the most stressful part of going to the doctor's office is sitting in the waiting room, not anticipating the prick of a needle or a dreaded diagnosis.

Patients complain that they spend more time in fluorescent-lit waiting rooms than with their doctors, and in an age of volume-driven medicine, waiting seems inevitable.

They crowd congested waiting rooms that echo with babies' screams and the "huffing and puffing" impatience of their fellow patients.

But at PartnerMD, they wait no more.

It was midmorning, and the PartnerMD waiting room was empty. Framed artwork and photography dotted the bright walls and complemented the comfortable, modern furniture. A receptionist answered a ringing phone behind a windowless desk. The office's quietude seemed antithetical to the success of the two-year-old membership medical practice.

A successful doctor's office without an overflowing waiting room?

As PartnerMD's president prepared to celebrate the company's second anniversary this Friday, she excitedly expected the western Henrico County membership practice to net $3 million in revenue in 2005, more than triple the company's revenue in 2003.

PartnerMD "really has exceeded my visualization of it," said Linda Nash, PartnerMD president. "Doing a startup is like raising a child; you never know how it will turn out."

Nash, a self-described "serial entrepreneur," began PartnerMD in February 2003 with five employees. Although Nash had heard about the recent trend of membership medicine, she didn't investigate it until she couldn't reach her doctor after she was thrown from a horse. She began researching membership, or concierge, medicine, which provides patients with 24-hour access to their primary care physicians and reduced waiting room times.

"A light bulb went off for me," Nash said, and several months later, she opened PartnerMD for Richmond-area patients.

Nash now employs 18 people and counts 700 individual patients and 600 corporate clients as members of the practice. PartnerMD's doctors, Virginia W. Kladder and Jim Mumper, each treat up to 600 individual patients, and in May, Nash will add an additional doctor to the practice. The company caps each doctor's number of patients to increase patients' access to their doctors.

PartnerMD doctors see 85 percent fewer patients than the average family practice. Kladder and Mumper each see between 10 and 14 patients a day; physicians in traditional medical practices see between 30 and 40 patients a day, Nash said.

Mumper, a family physician, worked for 16 years in one of these traditional medical practices. Frustrated by volume-driven medicine, Mumper joined PartnerMD as its first physician. He hasn't regretted his decision. "I feel so good about what I'm doing with patients," Mumper said. "I feel like I really get to know my patients well, spend a lot of time with them and that we can pull everything together and give them the full package." Annual PartnerMD membership, which is not a replacement for insurance coverage, costs $1,700 for individuals, $2,700 for a couple and $500 per child. The practice charges no initiation fee and accepts most major insurance carriers and Medicare.

PartnerMD guarantees patients half-hour appointment slots, same-day appointments and minimal -- if any -- waiting, which fosters a positive relationship between the doctor and the patient, said Kladder, a primary care physician who joined PartnerMD in July 2004.

"It's a dream of every person who goes into primary care that they will develop personal relationships with their patients," Kladder said. "What I really love about PartnerMD is that I get to know my patients. . . . It's a wonderful way to practice medicine."

Ninety-five percent of PartnerMD customers return to the practice, Nash said, and most new customers come to PartnerMD via the referral of satisfied PartnerMD customers. PartnerMD patients Linda and Ken Roberts, have been so pleased with PartnerMD that the self-employed western Henrico couple won't leave Richmond.

"I would not think of leaving Richmond as long as PartnerMD is operational," said Linda Roberts, 62, "and I hope that their model will be copied elsewhere in the country so that others will have such fine access to great medical care."

PartnerMD is one of about 250 membership medical practices in the United States, Nash said. She expects to open a second membership medical practice in Northern Virginia in 2005. This "health care on demand" provides Roberts and other patients with unlimited, constant access to a PartnerMD physician. Roberts recalled discussing a medical condition with her doctor at 9 on a Friday night and another time, visiting a spine surgeon with her PartnerMD physician. Her PartnerMD physician asked the questions that she was unable to ask, Roberts said.

"They facilitate your medical care in every possible way," she said. This medical advocacy is just one of the key features of the PartnerMD practice, Nash said. Other notable services include an extensive annual health exam, an emphasis on proactive medicine and the constant access to their physicians. Frank Lennon, a vice president of The Brink's Co., joined PartnerMD after signing up his business for the comprehensive health exams that PartnerMD offers to corporate clients. He became an individual client and hasn't been disappointed.

"It's almost like old-fashioned medicine," Lennon said. "I find that when I visit them it's in a very relaxed, very unhurried atmosphere. I have all the time that I want with the doctor, face-to-face . . . and my health today is better than it has been in years."