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VOL. 45 | NO. 14 | Friday, April 2, 2021

Open your door and say ‘Ahhhh’

House calls are a phone call away for those who prefer – and can pay

By Hollie Deese

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Jacob Melnychuk grew up in San Jose, California, where he occasionally skipped science class at Leland High School to surf.

“I was a terrible high school student,” he admits.

But he also had a genuine sense of community, which rallied around the family of Pat Tillman, a fellow Leland graduate, after the Army Ranger was killed in Afghanistan in 2004. Tillman’s family was a staple in their community, and it was upsetting to Melnychuk to see how the military handled his death.

He had already completed EMT school after graduating from high school in 2004 and had begun firefighting school before he enlisted in the Marines, where he became a combat medic, also known as a Fleet Marine Force corpsman.

“That was my initiation into medicine,” he says. “That is what gave me a passion for medicine, through serving in the Marines. I always knew that I wanted to take care of people. I just didn’t know in what capacity I wanted to do that. I always knew that I wanted to serve the community. I wanted to serve my neighbors.”

Now he’s serving his Nashville neighbors and others with his company, Delta Medics, a concierge medicine practice. The business, which he launched in 2020, took off because of the COVID pandemic and a need for testing. He advises construction teams about keeping workers safe during the pandemic on big projects like the recently opened Fifth + Broadway retail and restaurant development and the National Museum of African American Music.

“My phone hasn’t stopped ringing since June,” says Melnychuk, the company’s CEO. He started working with the Screen Actors Guild, bringing testing on-site to full-length feature films, as well as music video shoots for Dan and Shay, Jason Aldean, Kip Moore, Florida Georgia Line, Miranda Lambert and Taylor Swift.

Melnychuk says full concierge medicine will only grow post COVID, and his company isn’t the only one in the Nashville area using the concierge model. Some say newcomers from larger markets expect the service.

“This kind of medicine is more L.A., it’s more New York City,” he says. “It’s more Chicago, it’s more of metropolitan areas that are established in the idea of being cosmopolitan. But I guess you could say Nashville is that now.”

From Marines to Silicon Valley

Melnychuk says the military gave him direction and a passion for medicine and science.

“I think like most people in life we need to know why we’re here. I needed to have a sense of purpose and a sense of reason. And medicine gave me a sense of reason. Enlisting patients in the management of their own care gave me a sense of reason.”

Melnychuk was working in the dot-com industry in Silicon Valley post military with a company called Crossover Health that treated the employees of Apple and Facebook. From there, he was hired by Google to be part of the on-site nursing staff.

He says he loved it, but he had a couple of colleagues who worked for Vanderbilt and was able to take an educational opportunity there in the summer of 2014. He packed his bags and within a month had put in his notice at Google.

But Melnychuk, who has a biochemistry degree from Middle Tennessee State University (2014), as well as a nursing/paramedic degree that transferred to civilian life from his corpsman experience, says he wasn’t happy with the traditional model of seeing patients, maybe 20 or more a day, with barely any time to examine a chart or get to know that patient one-on-one, much less being able to know their habits or lifestyle in a way that could make a difference between health and illness.

“My genuine passion is making sure that people’s physical and mental health are OK,” he says. “The problem with medicine is the division between patient and provider has gotten so large that people have stopped taking care of themselves on a medicinal level.

“It’s not necessarily stopped, but there’s just a massive amount of people just waiting it out because they’re tired of waiting in long lines and they’re tired of going to urgent care or their primary care office and sit for two hours.”

He sought advice from a friend, Dr. Layla Alpers, about concierge medicine and launched Delta Medics. Then COVID struck.

“People wanted to get back to being around each other,” he says. “People miss their families. And it isn’t the physical ramifications of COVID-19 that I’m worried about. It’s the mental health ramifications.

“What people need now is testing. People want the peace of mind that they aren’t carrying it before they go and see their loved ones.

“If your primary care physician can do it, we can do it,” he says. “I think that people have gotten a taste of what it’s like to not have to interrupt their day to see your primary care provider. And it’s going to continue growing because people like the service, and they like the closeness.

“They like the patient interaction. They like having us one-on-one – there’s nobody in the waiting room. There’s no plastic that you’re sitting on. It’s from the comfort of your own space.”

Medical House Calls

After jewelry designer Judith Bright was diagnosed with COVID for the second time, her symptoms were much worse than the one day of fever and mild fatigue she experienced her first go-around. This time she had a fever that lasted 11 days, with heavy congestions and low oxygen saturation kicking in around Day Seven.

“I was coughing on every inhalation and I didn’t feel like I was getting enough air,” Bright says. When her oxygen levels were 89/90, her doctor told her she would have to go to a hospital if her levels did not rise.

Her doctor called in a five-day course of prednisone, but warned her it was not normally indicated in the treatment of COVID.

“I told her absolutely, and it did help, pretty immediately,” Bright adds. “I started working with a spirometer to expand my lungs and I took short walks in the halls outside my condo to get things moving in my lungs. The prednisone also helped me get my appetite back, so I believe the steroids really did the trick in getting me back to health.”

But in no way was Bright out of the woods. She still felt very weak and was having a hard time drinking enough fluids. At that point she had lost taste and smell, and was also febrile and extremely achy, taking Tylenol every 4-6 hours but it didn’t make the pain go away.

A friend of Bright’s sent her information for Medical House Calls. Bright texted the number.

“About 45 minutes later, a very nice and professional paramedic named Brendon was at my side giving me an IV cocktail of fluids, vitamins, minerals, pain reliever, anti-nausea medicine and steroids,” Bright recalls. “He was with me for a little over an hour while the IV ran in, and I felt immediately better.”

Bright says she was up for trying anything so she could remain at home, adding she believes the IV was pivotal in her ability to recover without having to leave for treatment.

“The energy it takes to go to an urgent care center when you are ill is counter-productive,” Bright says. “I love this business and I believe that it is the future of urgent care and in-home health and wellness. Additionally, the interaction with your caregiver is more human – calmer, slower-paced and ultimately more healing. You really feel cared for.”

Bright was cared for by a paramedic contracted by Stu Jones for his company, Medical House Calls, which offers concierge urgent medical care to patients in the comfort of their home, from IV therapy and in-home lab work to more serious conditions like kidney stones and fractures.

Jacob Melnychuk, CEO of Delta Medics, administers a COVID-19 test in the privacy and comfort of his patient’s home.

-- Photo By Michelle Morrow |The Ledger

Basically, Jones says to consider his company the same as one would an urgent care center, and he charges per-service fees, $249 for a house call, $99 for a telehealth call with prescriptions, as needed. But the concierge service gives families access to unlimited medical visits annually for a flat fee, either $2,500 or $5,000 annually for a household depending on the level of service needed.

Jones, a physician assistant (MSPA) with 28 years of experience, launched the in-home health care company in August 2020 – well into the COVID health crisis, though he is no newbie in the medical field. He spent a decade working in the emergency room at Williamson Medical Center before transitioning to orthopedics and sports medicine.

In 2006, he co-founded 7 Springs Orthopedics, a Brentwood-based practice with multiple locations throughout Middle Tennessee.

In 2018, 7 Springs sold to a venture capital group, and Jones stayed on for two years during the transition. In March 2020 he thought it was a good time to exit, right as COVID was hitting. He had already been thinking about concierge medical services and wanted to launch the new business in April, but COVID had to be addressed immediately in his new business. But rapid-testing materials were not yet readily available, so he took the summer off to get his ducks in a row before going full steam ahead.

“The initial thought process behind Medical House Calls was to do in-home urgent care, whether it’s stitches or you have an infection and need antibiotics or if you need a boot because you sprained your ankle,” he says. “And then we kind of grabbed COVID by the tail and that became our marketing tool for six months, because we were just doing COVID.”

Paramedics are allowed to perform a wide variety of medical treatments, including suturing, fracture care and intubation. EMTs can manage respiratory, cardiac and trauma emergencies. Advanced and intermediate EMTs can do more advanced medical procedures such as administering intravenous fluids and some medications.

EMTs cannot prescribe medicines.

In the last six months, Jones says, his company has done about 4,000 COVID tests, but recently has been getting back to non-COVID patients. Converting people into regular patients who initially contacted him for COVID testing and treatment is much easier now that people have spent a year having goods and services delivered to their homes, from groceries and wine to dog cleaning and even spray tanning.

“It just makes sense that you can get urgent care taken care of at home without insurance,” he says. “We don’t participate with insurance. You can take what you spend with us and turn it into your insurance and it will go towards your deductible. And we do take health savings cards or a family savings card through your insurance.”

Testing for international flights?

The boom in people moving to Nashville from other places has also pushed concierge medicine forward because it is just something they expect, and not just a few options here or there. And while they might not have as many choices as they are used to in other states, there are some other players in town.

DispatchHealth, which has locations across the country, including Nashville and Knoxville, sends two medical professionals, including a physician assistant or nurse practitioner along with a DispatchHealth Medical Technician, to every home visit, which can be scheduled in a matter of hours.

Nashville-based Complete Health Partners is providing on-site concierge COVID testing to movie crews and entertainment groups in Nashville such as 46 Entertainment, Alan Jackson’s band and crew, as well as providing back-to-work concierge testing services to big companies such as Tennessee Cheesecake and Gibson Guitars.

The company is also in negotiations with American Airlines to do mass COVID-testing for all customers seeking clearance for international flights for the next three years, says Brenda Geiger, marketing director for Complete Health Partners.

“When COVID hit last March, we had to turn on a dime to learn everything we could about successful management of COVID, not just testing,” Geiger recalls. “Our team has tested 50,000 Nashvillians in the past year in addition to caring for the urgent and primary care needs of our 10,000 patients.”

The company also is piloting multi-tiered concierge services for businesses to offer to their employees, from treating employees at their workplace to something more affordable ($50 a month per employee) to get primary care and telemedicine to businesses with 100-500 employees, including many Nashville restaurants.

This fills a gap for businesses that can’t provide insurance but can afford to provide a health plan to recruit and retain employees, says company founder Ty Babcock, M.D., whose CV states he is board-certified in emergency medicine.

“There’s 5,400 restaurant workers in the city, and most of them don’t have insurance,” Babcock says. “What we have put together is a subscription plan that their employer purchased for them. It’s much more affordable than insurance, and that’s an interesting segment of the population that we had not really dealt with a lot before COVID, but we really got into the concierge testing model where we do a lot of on-site testing for employers.”

But like Delta Medics, Babcock says his company performs on-site testing for people who may be in the public eye who prefer to be treated at home. It also is working on a large production, he says, and offers services to everyone from big name stars to production workers.

“We felt like we could really meet a need that exists, that we see that all the time for hospitality workers, but also in the music industry,” Babcock says. “I have a lot of personal friends who work in sound or as roadies, and they don’t have any health insurance.

“Sometimes we think of the music industry and it is people with lots of money, but there’s a lot of people out there that are struggling right now. And maybe they had health insurance, but they haven’t worked in six months.”

Babcock, who opened Complete Health Partners in 2018, also says he is working to come up with some solutions with concert promoters to try and figure out a way to test at live events to help restore the concert industry.

Babcock purchased a 21-foot trailer early in the pandemic to serve as a mobile rapid-testing site with on-site X-ray, electrocardiogram and PCR COVID testing equipment that could be instrumental at airports and other high-traffic venues, Geiger says.

“I do think that the people who can afford to have someone come to their house are more interested in that now than they were previously, because there is a bigger fear of catching something if they are out,” Babcock adds.

“Some people are very sensitive to the fact that they might be exposed to an infectious disease or something if they come to the clinic. And, so, the people that can afford to do so are choosing more and more to do that.”

Babcock says Complete Health Partners, which does not accept insurance for treatment, has set up a tiered system so all patients can have the benefit of at-home care, if needed.

“We wanted to make it affordable,” Babcock says. “We wanted to meet people where they were and be able to offer things that we see are important to health that are not covered by insurance.”

Melnychuk says his goal is also to provide the kind of health care and medicine services that will keep people healthy beyond the pandemic.

And while he has been slammed keeping up with testing on construction sites and movie sets, he also wants it to be the kind of service that is affordable to everyone.

Ultimately, what concierge medicine does, and has been sped up even further by the pandemic, is disrupt the accepted model of health care that has been the standard in this country for years.

“There’s a million urgent cares in Nashville,” Jones says. “But when you can disrupt the model and teach people they can get everything done at home, that changes everything.”

Melnychuk says concierge medicine is what is best for many patients, if not the traditional system.

“I think that we’re more concerned about the hospital’s bottom line than the patient’s overall health, from a primary care standpoint,” he says. “So that’s where I come in. I make sure that people don’t have to go out in the open when they are sick. That’s not proper medicine.

“Proper medicine is you staying in your pajamas, keep binging your Netflix, and I’ll be over there.”

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