Practice Philosophy & Goals

• To promote timely diagnosis & appropriate management of rheumatic diseases.
• To preserve patients' mobility & function.
• To promote patients' understanding of their rheumatic diseases & medications.
• To promote patients' autonomy by having patients actively collaborate in their disease management plans.
• To communicate & work as a team with patients' primary care physicians.

Why might you need to see a Rheumatologist?

You may be referred by your primary care physician or another physician who suspects that you have a rheumatic disease.

Examples of rheumatic diseases include:

• Rheumatoid arthritis
• Systemic lupus erythematosus
• Seronegative spondyloarthropathies
• Psoriatic arthritis
• Ankylosing spondylitis
• Reactive arthritis (formerly Reiter's syndrome)
• Enteropathic arthritis/Inflammatory bowel disease-associated arthritis
• Other undifferentiated inflammatory arthritis
• Osteoarthritis
• Osteoporosis
• Crystalline arthritis
• Gout
• Calcium pyrophosphate dihydrate (CPPD) arthritis
• Mixed connective tissue disease, overlap syndromes, and undifferentiated connective tissue disease
• Antiphospholipid antibody syndrome
• Systemic sclerosis/scleroderma
• Raynaud's phenomenon
• Sjogren's syndrome
• Idiopathic inflammatory myopathies
• Polymyositis
• Dermatomyositis
• Inclusion body myositis
• Vasculitides
• Giant cell arteritis
• Polymyalgia rheumatica
• Takayasu's arteritis
• Polyarteritis nodosa
• Primary angiitis of the central nervous system (PACNS)/CNS vasculitis
• Wegener's granulomatosis
• Microscopic polyangiitis
• Churg-Strauss syndrome
• Immune complex-mediated vasculitis (hypersensitivity vasculitis, urticarial vasculitis, cryoglobulinemic vasculitis, Henoch-Schonlein purpura)
• Behcet's disease
• Kawasaki's disease
• Relapsing polychondritis
• Adult-onset Still's disease
• Sarcoidosis
• Paget's disease of bone

Dr. Wachi's Credentials

Education
--Iolani School, 1994
--University of Hawai'i at Manoa, 1998 (BA in Biology & BA in English Literature)
--University of Hawai'i John A. Burns School of Medicine, 2003 (MD)


Residency & Fellowship
--University of Hawaii Internal Medicine Residency Program.  Intern, Resident, & Chief Medical Resident, 2003 - 2007
--University of Iowa Hospitals and Clinics.  Rheumatology Fellow, 2007 - 2009


Board Certifications
--Board Certified in Internal Medicine by the American Board of Internal Medicine, 2006 - 2016; re-certified 2016 - 2026.
--Board Certified in Rheumatology by the American Board of Internal Medicine, 2009 - 2019; re-certified 2019 - 2029.

Information About Establishing Care

How do I become a patient of this practice?

• Your primary care physician or another physician will refer you for a consultation because he/she is concerned about a rheumatic disease.
• I will contact you to make sure you understand why you are being referred, as well as how I bill for my services.
• If this is acceptable to both of us, we will schedule a consultation.
• Please have your medical records sent by your referring physician.
• If you have been seen previously, but have not been seen in over a year, you are no longer considered a current patient.  Please ask your primary care physician to initiate a new consultation request.

What to expect at the first visit

• Please arrive approximately 15 minutes early to complete introductory paperwork.
• You will be asked to review & sign our practice agreement.

What to bring to the first visit

• Any additional medical records you may possess (these will be copied & returned).
• A complete list of your current medications, including over-the-counter medications, vitamins, & other supplements.
• Alternatively, bring all your current, labeled medication containers.
• Your personal calendar, so that we may schedule any follow-up visits, if necessary.

What if I need to reschedule my appointment?

• Please let me know at least 24 - 48 hours in advance.
• If you are cancelling a Monday appointment, please try to let me know by end-of-business on Friday.
• Life happens--if you have to unexpectedly miss your appointment, please still call to let me know so I do not worry when you do not show up.
• WARNING: Patients who miss more than three visits without any advance notice will not be rescheduled.

The Micro-Practice

Where's the receptionist or nurse?

• This is a micro-practice; also known as a patient-centered practice.
• I wear many hats in this practice: rheumatologist, nurse, office manager, receptionist, information technologist, & janitor.
• Please be patient with me--I really am the only person who works here.
• A benefit of a micro-practice is that it keeps overhead costs low.  This allows me to:
• Spend as much time as you & I need to address your disease management.
• Improve communication with & education of my patients.
• Ensure that visits run on time.
• See you promptly, should you need an urgent, same-day appointment.

Who answers the phone & books my appointments?

• If you call the office during normal business hours & connect to the answering machine, I am most likely with a patient (who deserves my undivided attention).
• Please leave a message & I will return your call as soon as possible.
• Established patients will also have the option of leaving NON-URGENT messages by e-mail, cell phone voicemail, or cell phone text messaging.

How do I reach Dr. Wachi after her office is closed?

• After business hours, established patients can reach me on my cell phone/Blackberry (by standard phone call, text message, or e-mail).

An Insurance-Free Practice

Why isn't Dr. Wachi in the network of any health insurers?

• I do not believe that health insurers benefit either patients or physicians.
• Patients' health insurance premiums continue to increase.
• Physicians' reimbursements from health insurers continue to decrease.
• This is why physicians need to see more patients every day (& therefore spend less time per patient) in order to stay in business.
• Health insurers' regulations (as opposed from evidence from medical literature) often dictate how physicians practice medicine, which is not necessarily in the best interest of the patient.
• By foregoing third-party payors & contracting directly with my patients, any influence from health insurers is removed from the equation.
• My only obligation is to my patients, not to the health insurance companies.

Back to the old-fashioned way of billing: the self-pay model

• This is how your grandparents (or great-grandparents) paid for their medical care.
• At the end of the office visit, you will receive a bill & make payment at that time.
• Pricing for my services is transparent.

Is this a concierge practice?

• No.  There is no "membership fee" to be my patient.
• You pay only for services you receive directly from me.

What about other services Dr. Wachi orders?

• If you have health insurance that covers these things, it should continue to cover diagnostic tests, medications, or referrals, as per your insurer's & particular plan's usual policies.

How billing works

• This is a self-pay practice; patients are required to pay in full at the end of each visit.
• I am an out-of-network physician; I am not a provider for Medicare, Medicaid, or any of the private insurance plans.
• I do not bill insurance companies, but will supply you with the appropriate paperwork for you to submit to your insurance company for reimbursement.
• NOTE: you may NOT submit bills to Medicare for my services, as I am not a Medicare provider

Fee Schedule & What to Expect in Return

Office visits (consultations & follow-up care):

• The cost for the initial consultation is $1000.  This initial consultation typically takes between 90 to 120 minutes, depending on the complexity of the reason for referral.  
• If your case is so complex that this initial consultation surpasses 120 minutes, a charge of $276 per additional half hour will be applied.
• The cost for a follow-up visit is $276.  Follow-up visits typically last 45 to 60 minutes. 

Procedures (cost of medications is in addition to the cost of procedures)

• Arthocentesis (joint aspiration &/or injection) -- $150 per procedure site (small, medium, or large joint)
• Ganglion cyst aspiration -- $150 per procedure site
• Medications for injection -- cost dependent on price of individual medications.
• 2023 Corticosteroids: Methylprednisolone acetate (DepoMedrol), triamcinolone acetonide (Kenalog) = $90 for doses 20 - 80 mg (price for each single dose vial, dose notwithstanding).

Hawaii County GE Tax (4.712%) will be added to all billable charges
Accepted methods of payment: cash, checks, debit cards, & Visa/Mastercard


What you will receive in return

• Patient-centered, individualized, & collaborative care.
• On-time appointments, scheduled at your convenience.
• Adequate time to learn about your rheumatic disease & to address your concerns.
• Copies of all your office notes & diagnostic test results--you should leave each visit knowing what our management plan entails.