Murrison said the fee is affordable for middle-class households when compared with the cost of many consumer goods and services. "One of our goals is to democratize concierge medicine," he said.
For now, there may be fewer than 2,000 doctors in all types of retainer practice nationally. Most are primary care physicians, a sliver of the estimated 300,000 generalists.
The trend caught the eye of MedPAC, a commission created by Congress that advises lawmakers on Medicare and watches for problems with access. It hired consultants to investigate.
Their report, delivered last fall, found listings for 756 concierge doctors nationally, a five-fold increase from the number identified in a 2005 survey by the Government Accountability Office.
The transcript of a meeting last September at which the report was discussed reveals concerns among commission members that Medicare beneficiaries could face sharply reduced access if the trend accelerates.
"My worst fear — and I don't know how realistic it is — is that this is a harbinger of our approaching a tipping point," said MedPAC chairman Glenn Hackbarth, noting that "there's too much money" for doctors to pass up.
Hackbarth continued: "The nightmare I have — and, again, I don't know how realistic it is — is that a couple of these things come together, and you could have a quite dramatic erosion in access in a very short time."
Another commissioner at the meeting, Robert Berenson, called concierge medicine a "canary in the coal mine."
Several members said it appears to be fulfilling a central goal of Obama's overhaul, enhancing the role of primary care and restoring the doctor-patient relationship.
Yet the approach envisioned under the law is different from the one-on-one attention in concierge medicine. It calls for a team strategy where the doctor is helped by nurses and physician assistants, who handle much of the contact with patients.
John Goodman, a conservative health policy expert, predicts the health care law will drive more patients to try concierge medicine. "Seniors who can pay for it will go outside the system," he said.
MedPAC's Hackbarth declined to be interviewed. But Berenson, a physician and policy expert, said "the fact that excellent doctors are doing this suggests we've got a problem."
"The lesson is, if we don't attend to what is now a relatively small phenomenon, it's going to blow up," he added.
When a primary care doctor switches to concierge practice, it means several hundred Medicare beneficiaries must find another provider.
Medicare declined an interview on potential consequences. "There are no policy changes in the works at this time," said spokeswoman Ellen Griffith.
MedPAC report: http://tinyurl.com/3zjhh4e
GAO report: http://tinyurl.com/3mela6g
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