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Feb. 02--When one of Lisa Mehalick's six children falls ill, she calls Dr. Scott Serbin's cellphone, and he comes to her Pine home.
As they did in the 1950s, some doctors today make house calls.
Serbin is among an increasing number of physicians nationwide who are fed up with traditional medical practices that they say have grown complicated and impersonal. Their antidote is to form so-called concierge practices in which they collect monthly cash fees from patients instead of insurance reimbursements, and reduce the number of patients they treat to provide personalized service, such as visiting patients at home and taking calls 24 hours a day.
And many people, tired of long waits to see doctors and rushed appointments, are seeking out concierge practices.
"It's a movement that's growing at a rate of about 25 percent a year," said Tom Blue, chief strategy officer of the American Academy of Private Physicians, a Richmond, Va., nonprofit that represents concierge doctors.
As of fall, there were about 5,500 concierge doctors in the United States, up from about 4,400 a year earlier, Blue said.
Yet only 12 doctors have concierge practices in Western Pennsylvania -- a small number considering there are more than 3,000 physicians in Allegheny County.
Growth here likely has been stymied by UPMC and Highmark, which have sought to employ large numbers of doctors.
Once employed by a hospital system, employment contracts and non-compete clauses make it difficult for physicians to start independent practices, whether concierge or traditional, said John Krah, executive director of the Allegheny County Medical Society.
Concierge practices appeal to some doctors because of growing dissatisfaction with large impersonal practices; insurance coding and billing headaches; and administrative burdens that take away from time spent helping patients, Krah said.
"I've heard consistently from (concierge) docs that they are much more satisfied," he said.
Krah believes more doctors in Western Pennsylvania will move to establish concierge practices in the next several years, as more people convert to high-deductible health plans.
"If people are going to be paying out-of-pocket anyway, they may just go to a concierge," he said.
Most concierge doctors charge about $100 a month per patient. A typical concierge practice has between 300 and 600 patients, compared with a traditional practice in which each doctor is responsible for 1,000 to 2,000 patients.
Serbin, the area's only concierge pediatrician, limits the number of patients in his practice to about 320, giving him time for one-on-one care.
"They can always get an appointment the same day. They can always talk to me," said Serbin, who charges $55 to $105 a month per child, depending on age.
He keeps costs low by forgoing an office and visiting patients at home.
"The downside is it costs extra money, so it's not for everyone," he said.
Despite the cost, a concierge doctor is not just for the affluent, said Dr. Joel Warshaw, who runs an office-based concierge practice with about 600 patients in Bethel Park.
"I have a nice mix of people, some affluent, some not as much," said Warshaw, who charges $100 a month.
He started his practice seven years ago, and some patients are on fixed incomes, he said.
"The finances are really not that big of an issue for most people. ... They value their health."
New patients usually come to Warshaw because they're frustrated with their doctors, he said.
"The typical complaint is they can't get ahold of their doctor, the wait times; they're just frustrated," he said.
Mehalick switched to Serbin's practice soon after her third child was born because she was tired of taking one kid to the doctor and having the other two come down with a bug they picked up in the waiting room.
Nine years and three more children later, Mehalick values the home visits and the ability to call Serbin directly, she said.
"It was just unbelievable. I didn't have to go through any staffing," she said. "It was just priceless to me."
The American Academy of Private Physicians expects the number of concierge doctors to continue to grow as more doctors become dissatisfied with pressure from the government and insurance companies to cut costs, Blue said.
The Affordable Care Act may push patients to seek concierge practices, he said.
As more Americans gain health insurance coverage under the law, Blue said, patients may find there are not "enough docs to go around."
"The trend has been going on for quite some time," he said. "But the Affordable Care Act fanned the flame."
Alex Nixon is a Trib Total Media staff writer. Reach him at 412-320-7928 or firstname.lastname@example.org.
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