document: High-end medical option prompts Medicare worries High-end medical option prompts Medicare worries -LRB- AP -RRB- WASHINGTON -LRB- AP -RRB- -- Every year , thousands of people make a deal with their doctor : I 'll pay you a fixed annual fee , whether or not I need your services , and in return you 'll see me the day I call , remember who I am and what ails me , and give me your undivided attention . But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama 's health overhaul . The spread of '' `` concierge medicine , '' '' where doctors limit their practice to patients who pay a fee of about $ 1,500 a year , could drive a wedge among the insured . Eventually , people unable to afford the retainer might find themselves stuck on a lower tier , facing less time with doctors and longer waits . Medicare recipients , who account for a big share of patients in doctors ' offices , are the most vulnerable . The program 's financial troubles are causing doctors to reassess their participation . But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients . If concierge medicine goes beyond just a thriving niche , it could lead to a kind of insurance caste system . '' `` What we are looking at is the prospect of a more explicitly tiered system where people with money have a different kind of insurance relationship than most of the middle class , and where Medicare is no longer as universal as we would like it to be , '' '' said John Rother , policy director for AARP . Concierge doctors say they 're not out to exclude anyone , but are trying to recapture the personal connection shredded by modern medicine . Instead of juggling 2,000 or more patients , they can concentrate on a few hundred , stressing prevention and acting as advocates with specialists and hospitals . '' `` I do n't have to be looking at patient mix and how many are booked per hour , '' '' said Dr. Lewis Weiner , a primary care physician in Providence , R.I. , who 's been in a concierge practice since 2005 . '' `` I get to know the individual , '' '' Weiner said . '' `` I see their color . I see their moods . I pick up changes in their lives , new stressors that I would not have found as easily before . It 's been a very positive shift . '' '' Making the switch can also be economically rewarding . If 500 patients pay $ 1,500 apiece , that 's gross revenue of $ 750,000 for the practice . Many concierge doctors also bill Medicare and private insurance for services not covered by their retainer . Patients and family members say the fee is worth it . Linda Popkin lives in New York , far from her 97-year-old mother in Florida . With their mother in a concierge practice , Popkin says she and her siblings have direct access to the doctor as needed . '' `` If one of us calls the doctor , he calls us back , '' '' she said . '' `` We are involved in all the decisions . We definitely have peace of mind that Mom is seeing a doctor she can speak to if we have any questions . I 'm sure you 've heard the horror stories about people calling the doctor and they ca n't get in for three weeks . '' '' Popkin 's mother did n't lose her Medicare . She 's still covered for medications , specialist visits , hospitalizations and other services . But she has an additional level of personalized attention . Her doctor is affiliated with a Florida-based management company called MDVIP , a wholly owned subsidiary of consumer products giant Procter & Gamble that represents the largest group of concierge physicians in the country . MDVIP marketing executive Mark Murrison says its doctors do not sell access , but a level of clinical services above what Medicare or private insurance cover . The cornerstone is an intensive annual physical focused on prevention . About half the patients are Medicare beneficiaries . Retainer fees range from $ 1,500 to $ 1,800 a year , and MDVIP collects $ 500 of that for legal , regulatory and other support services . 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 do n'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 do n'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 do n'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 . ___
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