A tuneup for top officers
New health care options are heavy on personal attention

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by Marjolijn Bijlefeld
for Virginia Business Options
March 2006

Protecting the health of a company’s senior officers is similar to running a race car: top performance depends on attention from a personal pit crew. And now business executives can get that kind of attention — a deluxe tuneup of sorts — at a doctor’s office. “Business owners think nothing of buying a maintenance contract for their BMW, but they don’t think about protecting their greatest asset — their executives,” says Dr. J. Rand Baggesen, a physician and the administrator in charge of the Executive Health Evaluation program at CJW Levinson Heart Hospital in Richmond.

Opened last March, the program draws patients who come for the half-day or longer executive evaluation, which includes an intensive physical exam with diagnostic tests, as well as diet, exercise and stress management consultations.

That kind of attention appealed to Michael Laming, 54, senior vice president of human resources for Genworth Financial, headquartered in Richmond. Last fall, his company signed on with CJW’s program to provide evaluations for its senior officers. Compared to a routine physical in a busy family practice, “this is like peeling the onion,” says Laming, because the thorough process peels away layer after layer of medical information. “I had three hours of dedicated time, received the best physical of my life and was back in the office after lunch. The program is comprehensive, educational and diagnostic. It’s smart medicine and a smart benefit that a company can provide to its people,” he says.

Throughout Virginia, emerging options in health care for business executives are heavy on both personal attention and high technology. The two are not mutually exclusive. Baggesen’s program, for instance, uses a carotid artery scan that can detect the earliest buildup of plaque, an indicator of potential cardiovascular problems.

“There is a strong correlation on autopsy results between carotid and coronary artery blockages,” Baggesen says. “Vascular disease is a whole body disease. Considering that the first symptom of heart attack in about 50 percent of the patients is sudden death, being able to tease out information early can help us treat early.”

After the physical, executives get their own version of a smiley face sticker — a VitalKey, a lighter-sized computer memory device that stores medical information and even some medical images. In an emergency, the medical information stored on the USB thumb drive can be accessed from any computer.

Executive physicals aren’t new. The Mayo Clinic and Greenbrier Clinic, among other nationally recognized facilities, have been offering such services for years. Companies increasingly are offering the perk, and picking up the tab, since these super-size exams aren’t covered by insurance. Sentara opened its Executive Evaluation Center in Norfolk seven years ago and has seen nearly 5,000 patients. In December, the Inova Heart and Vascular Institute opened Inova Executive Health Center in Falls Church. As local programs become more prevalent, exams and tests can be more tailored to an individual’s needs, says Baggesen. Plus, patients have more flexibility for follow-up and scheduling additional tests.

Meanwhile, around the state, medical technology is advancing so rapidly that treatment options today are significantly different from what they were just a few years ago. These treatments are typically covered by insurers and available to anyone who seeks them out. In some cases, they resemble the hands-on approach of the executive physical.

Dr. Christopher S. Walsh is medical director of Mid-Rivers Cancer Center in Montross on the Northern Neck. It opened this fall as an alternative to hospital-owned cancer treatment centers. In treating patients, Walsh combines state-of-the-art technology, including next-day delivery of customized filters that conform exactly to the patient’s tumor, delivering radiation to the tumor’s location and shape while protecting the surrounding tissue. As a safety check and also to reassure patients, Walsh uses software that plays a unique set of musical notes when the barcode on the patient’s chart and the instructions for the treatment settings match.

That’s the high-tech part. The personal touch comes in Walsh’s presence for the entire process. During the 12 years he was medical director of the Cancer Center of Virginia in Fredericksburg, one frustration was the small amount of time he could spend in preparing a patient’s treatment plan. “Before, I had an hour at most to develop a plan,” he says.

Now he takes as long as he needs. For one patient with locally advanced lung cancer, the planning process alone took 25 hours. “This patient is potentially curable. But if you can only spend an hour on the planning, the prediction that this is an incurable case becomes self-fulfilling,” Walsh says.

The treatments themselves aren’t longer, he says. Most patients complete their treatment in 25 minutes or so, even with a verbal system of checking and rechecking equipment settings, a protocol Walsh developed using aviation safety as a model. “In terms of the communication between pilot, co-pilot and control tower, it’s very similar. That’s a systematic and rehearsed interaction. Our patients hear that whole process enunciated every time. It’s not that I don’t trust the technicians or the technology. Safety has nothing to do with trust. It’s a system property.”

Dr. Gary Simonds, a Carilion neurosurgeon in Roanoke, says cancer treatments began changing dramatically with the development of stereotactic radiation. “Rather than just blast radiation through an area of the body to hit a target that is in the middle of other tissue, stereotactic radiation takes small beams and shoots it from different angles.” The result is that any spot along a beam gets a low dose of radiation, but where the beams cross at the targeted tumor the dosage is high.

With the fine-tuning of such technology, Carilion Cancer Center of Western Virginia was the first in the state to acquire the CyberKnife, a miniature linear accelerator that generates radiation beams. The robotic arm can direct the radiation to the right spot, adjust for small patient movements, and — because it can configure the beams to any shape — be used anywhere on the body. Now, patients lie in a foam cradle, a more pleasant option than the old immobilizing restraints, which required screwing a frame onto a patient’s head. “Some treatments are better delivered over four or five sessions,” notes Simonds. Patients who underwent the older procedures wanted to get it over with, not come back for multiple sessions.

“With CyberKnife, in several sessions, patients can walk in, get the treatment and walk out the same day. In many cases, there is no surgery and no days of hospitalization, and the results are beating what we were getting with surgery,” he adds.

Cardiac care is also seeing similar leaps forward. When the six-story, 324,000-square-foot Sentara Heart Hospital in Norfolk opened in late February, it included five “Smart ORs,” operating rooms where the equipment is voice-activated. The challenge has been to design the hospital to include the latest diagnostic equipment while anticipating changes in technology in the next few years, says Lynn Holder, vice president for cardiac, vascular and transplant services at Sentara.

Holder provides this example to illustrate the rapid pace of change. As a human fetus grows, a small hole in the wall between the top two chambers of the heart closes. Or at least it should, but it’s fairly common that it doesn’t. “It can be so small, that there’s really no issue until the person reaches mid-life. Up until about 18 months ago, fixing that problem required an open-heart surgery procedure. But today, we can repair it using catheters fed through blood vessels,” she says. The patient can be back at work in a matter of days, compared to a typical six-week recovery following an open-heart procedure.

Sentara Heart Hospital also has a dedicated cardiac e-ICU, a monitoring system where a medical team 12 miles from the hospital is constantly watching the key clinical signs of these patients. “One of the issues in critical care is that a patient’s condition can change at any time. The quicker we can stabilize that, the quicker they get well.”

For the nursing staff, it means that there is instant access to a team to guide them through intervention or let them know if the cardiologist should be contacted. That can be reassuring in the middle of the night.

The diagnosis of cardiac conditions — or other disorders — is being helped along at Inova Mount Vernon Hospital in Alexandria by the acquisition of a 64-channel CT scanner that provides an image of any organ in one second and can scan the entire body in fewer than 10 seconds. In one rotation, the scanner creates 64 images, which combine to form a 3-D view. This quick scan can capture images of the heart and coronary arteries in fewer than five heartbeats, meaning patients have to hold their breath for only a few seconds. That has significant applications in the emergency room, where patients coming in with chest pain are often kept hours for observation. With this noninvasive scan, doctors can quickly check for heart attack, pulmonary embolism or aortic dissection.

Today, technological advances center on diagnosis and treatment. Predicts Sentara’s Holder, “In the not too distant future, we’ll be talking about biogenetics and how we can actually use gene compositions to change the risk factors people have so they are less likely to develop heart disease.” Yet even as technology continues to improve, it is clear to physicians like Baggesen and Walsh that the demand for a doctor’s hands-on involvement remains high.