Doctor eschews insurance, launches concierge practice

Saturday, October 13, 2007

By Joe Fahy, Pittsburgh Post-Gazette

Andy Starnes / Post-Gazette

Dr. Joel Warshaw examines a patient, Mary Cindrich, in his Mt. Lebanon office.

When she heard that her family physician, Dr. Joel Warshaw, was scaling back the size of his medical practice to provide better service, Mary Cindrich was immediately interested.

Beginning Jan. 1, he is starting the area's first "concierge" internal medical practice for adults and older children. A local pediatrician, Dr. Scott Serbin, established a similar practice for young people in 2004.

Patients will be able to call Dr. Warshaw directly, even on weekends and holidays. If necessary, he'll meet them in the emergency room or make house calls. And he promises same-day or next-day appointments, even for nonemergencies.

The service comes with a price: $1,000 to $1,500 per year for most adults, with discounts for couples and older children. But to Mrs. Cindrich and her husband, Ralph -- an attorney who represents Steelers linebacker James Farrior and other NFL players -- the combined $2,250 fee is worth it.

"We have a very busy, hectic lifestyle," she said, noting they just sold their home in Mt. Lebanon and plan to move to a new Downtown waterfront development, 151 First Side, early next year. They also have a home in California.

"The thought of having access to a doctor convenient to our time schedule is very appealing to us," Mrs. Cindrich said.

Even more important to her is the idea that thorough, readily available care could head off potential medical problems. She and her husband are in their 50s and in good health.

While details vary, concierge medicine typically involves paying a fee in exchange for greater access to the doctor. Critics have suggested that it caters to people with higher incomes, though Dr. Warshaw said his fees are relatively low.

"I'm offering higher level care, with an emphasis on prevention, not only to the wealthy, but to anyone interested in their health," he said.

People have a similar choice, he said, in deciding whether to send their children to private school or to pay for first-class airline seats.

He invited not only his current patients, but others who may be interested in his new concierge practice, to visit his Web site, www.warshawMD.com.

Dr. Warshaw recently sent notification letters to 4,500 patients assigned to him in the six-member medical group in Mt. Lebanon where he now practices, along with an explanation of his new venture and a list of fees. Patients were invited to sign up for his new practice, Premier Personal Healthcare, but he will limit it to about 600 patients. Those who don't sign up will have to find another doctor, and he suggested that they consider one of his current partners.

"I have given this a great deal of thought and have explored many other alternatives," he wrote in the letter. "Unfortunately, the one inescapable conclusion I have reached is that health care has changed over the years, and it's only getting worse."

Dr. Warshaw said he regretted having to end his professional relationship with some patients, but noted: "I'm interested in the quality of my health care, not the quantity."

Under the new approach, he will no longer accept private insurance or Medicare payments. Patients would retain that coverage, though, for care from specialists or for other services outside his office, such as lab tests or X-rays.

So far, interest from patients in the new approach has been strong, Dr. Warshaw said. They are being sent additional information and, if they opt to continue under his care, could pay the annual fee in monthly installments.

"In the end, what you are offering wins out for me," one patient wrote to him. "I don't like feeling rushed at the office. I know there are others waiting to see the doctor and there have been times where I haven't mentioned something else that was bothering me. So what you are offering seems ideal."

Still others have told him that they cannot afford to remain with his new practice, though there are some savings for patients under the new arrangement. Patients can have unlimited office visits at no additional cost, for example, while many would have copays for each office visit under conventional insurance.

Some also could save money by switching to high-deductible insurance plans, a move Dr. Warshaw is encouraging. If he provides the bulk of their medical treatment, they may have limited additional costs for care.

In some cases, patients also may be able to use funds from flexible spending or health savings accounts to cover his annual fee.

In his concierge practice, Dr. Serbin sees about 300 patients, down from about 3,000 when he left his conventional practice three years ago.

"Financially, it hasn't been great," he said. "But from the job satisfaction standpoint and the patient satisfaction standpoint, it's been terrific."

The practice is continuing to grow and includes plenty of patients from families of fairly modest means, he said. Home visits have become so popular that beginning Dec. 1, he plans to devote his practice exclusively to house calls.

Perhaps 300 to 500 physicians across the nation are practicing concierge medicine, said Jack Marquis, a Michigan attorney who advises doctors interested in the approach.

"It's not going to take over the practice of medicine, but I think there will be more and more physicians doing this," he said.

Some of those doctors continue to bill Medicare and private insurance, but also charge patients fees, he said. Still others stop taking Medicare and insurance payments. Doing so, said Dr. Warshaw, will allow him to save money on billing, a significant cost in many practices.

Concierge medicine wouldn't have gained momentum, Mr. Marquis said, if payment rates from Medicare and private insurers hadn't declined. Doctors have typically responded by seeing more patients, and some have concluded, "I'm not going to do this anymore," he said.

Another frustration is the limited time that doctors have to manage patients with diabetes or other chronic illnesses, said Jack Krah, executive director of the Allegheny County Medical Society.

He said that if Dr. Warshaw is successful in establishing a concierge practice, "you can expect to see more physicians follow this model."

Having a more personal relationship with the doctor is a "throwback to the old days" of medical care, Mrs. Cindrich said. "It's exciting to know we'll have that kind of service."