A Charlotte executive journeyed to Libya for a pleasure hike in the Sahara. At a Tripoli hotel, he developed a kidney stone. The pain was intense.
He contacted Dr. Jordan Lipton of Signature Healthcare, PLLC, who guided him to the proper pain reliever in a travel medication bag that had been prepared by Signature partner Dr. Bryan Woodward. The would-be desert wanderer stemmed his suffering and, two days later, returned home to pass the stone.
He was fortunate to be a patient of Signature Healthcare, a group of Charlotte doctors who provide comprehensive medical care to a membership group 24/7. Partners Lipton, Woodward and Elizabeth Perry even allow their patients access to their cell phones, and one of them is always on call. Each will counsel patients via phone and will see them at their homes, in their offices or at a hospital emergency room, as well as in the Signature Healthcare medical complex in the SouthPark area.
Signature Healthcare is a membership-based concierge primary care medical practice with a mission to provide patients greater access to physicians. The doctors offer individual attention, same-day or next-day appointments and a wide range of services.
“The typical primary care doctor has about 3,000 to 4,000 patients,” Woodward explains. “Our total patient population will never be more than about 350 per doctor. That way we can provide the best care possible in a more timely fashion.”
Like all Signature Healthcare’s patients, the traveler to Libya paid a membership fee that doctors Lipton, Perry and Woodward say is the reason they can provide such individual care. Referred to as a “concierge” or “membership-based” medical practice, the concept was born in Seattle in the late 1990s.
According to its founders, Signature Healthcare became the first such practice in the Carolinas when it opened in March 2003. Now there are at least a couple of other Carolinas practices operating loosely according to the same plan – one in Greensboro and another in Charleston, S.C.
Signature Healthcare charges its member patients an annual fee of $2,500. A second family member can join for $2,250, a third for $2,000, and a youth aged 5 to 18 for $1,250.
The fee generally is an out-of-pocket cost. It does not cover an individual’s medical expenses. The patient’s insurance provider remains responsible for the lion’s share of those, just as in other practices. The fee may not be reimbursable by tax-deferred plans.
The fee makes it possible for Lipton, Perry and Woodward to keep their patient load low and stay up-to-date in detail on each client’s medical situation. And it makes the anytime attention possible.
If an elderly patient has a swollen leg, for example, one of the three doctors might make a house call. And in a critical situation, one of the trio will meet a patient at a hospital emergency room.
Woodward recalls a patient who called him at 6:00 a.m. with chest pains. He sent her to a hospital and promised to meet her there. When the emergency room doctor began examining her, she told him her doctor was on the way.
The emergency room doctor was incredulous, Woodward says. “He told her, ‘A primary care physician hasn’t been here to evaluate their own patient in five years.’ I walked in and she said, ‘See?’ The doctor handed me her chart and walked out. I took care of the patient, admitted her to the hospital, consulted with cardiology and we got her situation taken care of.”
Such an episode isn’t unusual for the Signature Healthcare doctors. “We’re all board certified in primary care and emergency medicine,” Woodward says. “We can see patients in the emergency room and we can also admit them to the hospital.”
Outfitted to Impress
This same emphasis that Lipton, Perry and Woodward place on personal attention is also reflected in the thoughtfully appointed interiors of their offices. These include warmly finished hardwood floors, wide soft-lit hallways, large examination rooms with individual temperature controls, and full-coverage patient gowns and warmed robes. Classical music wafts through speakers and collector-quality art adorns the walls. Lipton’s wife Siu is a professor of art history and has made arrangements with local artists and galleries to display works that a patient can buy right off the wall.
The offices are also outfitted with a full laboratory with x-ray and other equipment that enable the partners to perform as diverse tasks as administer intravenous fluids, treat migraine headaches and patch lacerations and fractures on site.
“We save the patient time,” points out Woodward, “and we even save the insurance companies money.”
Lipton explains: “At most practices, after hours, patients never speak to a doctor; they go to an emergency room. The patient pays a $150 insurance co-pay and waits six hours. The insurance company pays two to four times what it would have cost for a doctor to see that patient in the office. When you call our office, you might pay your $25 co-pay and get taken care of here for about one-quarter of the cost to the insurance company. This is in addition to the time savings for the patient.”
Perry picks up the point. “We avoid hospitalizing people,” she says. “We can treat them here for $200 compared to a $1,000-a-day hospital stay.”
After initially trying to outlaw concierge medical practices in Washington state, Perry says, insurance firms now are beginning to understand them.
Still, there’s criticism from some quarters that the concept is elitist. Indeed, fully 70 percent of Signature Healthcare’s patients enjoy a six-figure household income, with most being business executives aged 30 to 60. About eight percent are younger than 18 and another 20 percent are seniors. Perry acknowledges that some of the seniors pinch pennies to pay the annual fee.
Saving More Than Time and Money
But Lipton defends membership medicine with a business example. “The banks have no qualms about using the company jet or sending people first class when they travel to New York or someplace,” he says. “It saves the company time and money. We save people time, in addition to their lives on occasion.”
David Swimmer says they might have saved his. The president of Charlotte’s Swimmer Insurance Agency, he was among those who attended a focus session the doctors put on at a wine shop to gauge consumer appetite for a concierge medical practice before launching the business. At the time, Swimmer had a good doctor at a small practice and thought he’d never need such a service. Then, in 2004, his health took a sharp turn.
“Out of the blue, I got dizzy,” Swimmer remembers. “I had severe vertigo and was nauseous. I was almost incapacitated. I felt I needed somebody I could go to rather than an emergency room. I called Jordan Lipton and said, ‘I’m ready to join.’”
“Bryan Woodward had me in a CAT scan of my brain in 45 minutes,” Swimmer continues. Swimmer was 48 and, during his Signature Healthcare office visit, registered nurse Amy Ascolese administered a prostate test that he normally wouldn’t have received, since insurance doesn’t cover it for men younger than 50.
The test showed Swimmer had prostate cancer.
“They got me straightaway to the best urologist and the best surgeon,” he says. “Now all is well.”
Swimmer sees administration of the critical test that few get before 50 as a perk of being a Signature Healthcare member. “The fee becomes a non-issue when you find out you need something,” he says.
Lipton, Perry and Woodward say stories such as Swimmer’s emphasize that starting their own business was the right move, even though their physician friends were leery.
“They said it’s a great idea, but you’re nuts,” Perry recalls.
Doctors are risk averse, all three say, and many face a mountain of debt from school days. Further, they struggle with malpractice insurance costs and most have non-compete contracts. A guaranteed income with a big hospital or medical practice seems safe and prudent.
A Healthier Way to Practice
Lipton, 40, and Perry, 39, had been thinking of other practice options while working in an emergency medicine practice owned by Carolinas HealthCare System. When a private group took over the emergency services contract, the two were offered jobs but turned them down. They were in the full throes of the membership medicine bug that, months earlier, had started as scratching on a cocktail napkin at the end of a day.
At the time, Woodward, 44, was practicing in the Gaston Memorial Hospital emergency room; he joined the venture nine months later.
They jokingly called their projected practice “Starbucks Medical” because they shared a mutual taste for coffee and held multiple meetings at a South Charlotte java shop. Perry’s husband Jon, who earned an MBA at the prestigious Wharton School, acted as an unpaid consultant.
Though they could have found backers, each funded a third of the just-under $1 million startup costs with a personal bank loan. “We wanted to remain independent, so we can make the rules ourselves,” Lipton says.
They signed their first patient the day after they opened the office doors.
Each of the partners had always wanted to be a doctor; Woodward and Lipton had doctor dads. Though they love medicine, they acknowledge they don’t know much about business.
Their business executive patients advised them not to expect to make money for three years, but they achieved a positive cash flow late in 2004. They aren’t taking salaries as high as they were making previously, but they’re heartened by the practice’s growth.
“My husband keeps saying ‘You’re doing great,’” Perry grins. “It doesn’t feel like work because the way we practice is so much more enjoyable.”
They’re building their patient rolls and wouldn’t mind having a total of 1,200 to 1,400, especially if they also lured one more partner. They feel a patient load of about 300 to 350 per doctor is manageable for maintaining the personal patient attention they want to deliver.
Another area for development is attracting corporate members. Though several executives from various large corporations belong, and many of their patients own their own firms, signing up businesses is a slow process.
The doctors say they are content to grow steadily, mainly through word-of-mouth, spurred on with occasional media attention and punctuated with special events to acquaint prospects with the concept of concierge care.“Referrals from members are the best way to grow, or with people who read about us and our members’ experiences,” Perry says. “We are very confident that we’ve made a healthy choice both in our own way of practice and in delivering healthcare to others.”