ER docs offer concierge service for a price
While working in Martha's Vineyard Hospital's emergency room during the Island's busy summers, Dr. Jeffrey Zack and Dr. Sean Kelly realized many seasonal visitors sought care there because they did not know where else to go.
Seeing a niche they thought they could fill outside of their regular hospital work hours, Dr. Zack and Dr. Kelly created Lifeguard Medical Group, a concierge medical practice for summer residents willing to pay a premium for care that includes house calls and on-call service around the clock.
The two physicians sat down for an interview at 7:30 am early last week. A bleary-eyed Dr. Zack had just finished a 12-hour shift in the hospital emergency room (ER). He planned to head home to sleep, while Dr. Kelly would be on call should any Lifeguard patients require care.
This marks the second year for the sideline business. "We both had been working in ER for a while and saw a lot of seasonal residents that didn't have physicians, or at least Island physicians or specialists here," said Dr. Zack, "who would come in and have plenty of medical problems and no sort of base here on the Island to obtain their medical care."
He said that often places the onus for care on emergency room physicians, who may not have the benefit of the patients' background information, medical history and records. "It makes our job much harder and more difficult to do, and it can take hours for us to get those sort of medical records here, in order to take care of the patient in the best way possible," said Dr. Zack.
Lifeguard offers full services to seasonal residents of Martha's Vineyard from Memorial Day weekend to Columbus Day. According to information on the company website, the cost of full-seasonal memberships runs $7,500 ($375 a week) for an individual plan, $12,000 ($600 a week) for an individual plus one plan, $15,000 ($750 a week) for a family plan for three to five people, and $1,000 ($50 a week) for additional members. A deluxe plan is available which offers coverage to all household visitors or employees, as well as family members. Additional charges may apply depending on individual care needs.
"We're not primary care doctors - we're not specialists - we're emergency physicians, and we add to patients' care when they come in the ER here," Dr. Zack explained. "We just take that to a different level, the way you would want to be cared for. They don't need their whole system of off-Island physicians duplicated - they just need a safety net. That's how the concept came up - we thought, why can't we do that?"
Photos by Ralph Stewart
"I like the way you phrased it to a couple of patients," Dr. Kelly added. "We act like their primary care physicians' and specialists' eyes, ears, and brains on the Island. We're kind of like an extension of them, to coordinate their patients' care and harmonize, rather than being another cook in the kitchen."
They are careful to point out that their concierge practice is a separate entity from Martha's Vineyard Hospital, which is a nonprofit organization. They do, however, utilize the hospital's resources as much as possible for laboratory and diagnostic tests, Dr. Zack said. Costs for treatment and tests are submitted to patients' insurance companies by a billing service.
Rather than siphoning off business from the hospital, Dr. Kelly said the concierge practice helps prevent some unnecessary visits to the ER. "And if we determine on the phone and when we see them that patients need to be in the ER, then they appropriately get triaged to go there," he said. "A lot of the visits can be avoided, not prevented, by either being proactive or by doing a home visit."
Dr. Kelly said he and Dr. Zack try to integrate with the system as an added resource. "Here on the Island, it's not a situation where there aren't enough patients - it's a situation where there are not enough doctors and resources," Dr. Kelly said. "The ones who are here are great and provide superb care - it's just that there are so many more people in the summer and in the season than there are facilities and doctors."
He added, "Of course, we're building a new hospital and hopefully we'll get some new staff, so that's all going in the right direction, but we're still in the situation where there are just so many people out there that need to be seen than can be handled."
The two physicians meet with patients to gather information from past medical records, discuss medical history with the patients' primary care and specialist physicians, and download their healthcare information into a secure on-line database accessible by the patient anywhere at any time.
"We develop an online medical record for them that quickly makes the delivery of care much safer - we don't duplicate tests that aren't necessary," said Dr. Zack. "We can compare the last chest x-rays or EKG's. Instead of spending hours trying to find that information, having it at your fingertips instantaneously can make a big difference in the care of someone if they are ill, especially if it's a life or death issue and minutes matter."
Asked to describe typical Lifeguard clients, Dr. Zack said they range from many older patients with medical conditions related to aging, to those who want the convenience and security of an on-call physician for conditions ranging from minor illness to major trauma to recurring health issues that require monitoring.
"It varies from weekly visits and even more frequently for certain people, to several patients who say basically a good summer is, 'We don't talk - all I want to know is you're there, and that's enough for me. It's great to meet you, and I hope we don't speak, and at the end of the summer, we'll smile on the way home from the Island as we leave,'" Dr. Kelly added.
Patients with heart or neurological problems who need close monitoring might think twice about vacationing on the Island, in case their conditions worsen. "We try our best to provide that service for them that they now have a level of comfort, so they stay here and relax and know that if something happens, someone's available 24/7, they have good access," Dr. Kelly said. "And if they need to get off the Island to go home, we can facilitate that for them and coordinate care with doctors at home. It eliminates a lot of waste in the system, because we coordinate with their own doctors to make sure their care is optimized."
The Lifeguard physicians also offer fitness and wellness services, coordinate follow-up treatments off-Island, and provide expertise and up-to-date information on diseases endemic to Martha's Vineyard, such as Lyme disease, babesiosis, and tularemia.
At a time when advanced medical technology is available, the two doctors have found one of the services their patients like best is the old-fashioned house call. They prefer to see their patients at home, which they believe is unique to their concierge practice.
Friends as well as colleagues, the two physicians are board-certified in emergency medicine. Dr. Zack also holds a degree in tropical medicine and travelers health. He has worked at Martha's Vineyard Hospital for five years. During the winter, Dr. Zack divides his time between the Island and Providence, where he works at Rhode Island Hospital on the faculty for the Brown University Medical School and Emergency Medicine Residency programs.
Dr. Kelly works on the Island about two weeks a month during the summer season, and lives in the Boston area. He works at Beth Israel Deaconess in Boston, where he is Associate Director of Graduate Medical Education, and at Harvard Medical School, where he is an instructor of medicine. Dr. Kelly also serves as a visiting professor at the University of Florence in Italy, and as a First Aid physician at Fenway Park.
Both doctors said they keep fresh on medical updates by staying active in the academic community, which also provides opportunities to develop relationships with other medical professionals and care centers.
As husbands and fathers of young children, they said juggling their many jobs takes balance - and the help of very supportive families.
"We want to find the right balance, and the cost of doing that," said Dr. Zack. "So I think approaching it cautiously is the best way to do that. We want to build this business in the right way, and with quality and service as the biggest factors."