Don’t replicate, innovate.

“Avoid formulas, brands, and models that work against you implementing your unique vision of healthcare. Don’t replicate, innovate. And, do so using the referenced structuring that for decades has achieved Medicare compliance and tax-advantaged funding options. Call the practice whatever you want, incorporate whatever healthcare services you wish into your subscription, and don’t be constrained by the ill-informed guidance in this marketplace that is not using existing laws/guidance to maximize your practice’s potential.” (Eischen; 2025)

“Because each concierge practice has unique patient fee agreements to consider, there is not a “one size fits all” approach to advising these practices. Concierge practices should not overlook the unique legal and practice issues facing them, from patient fee issues to physician departures. These models have a variety of legal challenges that should be addressed at the early stages of the practice, so they do not lead to partner and patient discord later on.” (Eimer; 2025)

Don’t let Guilt Drive Your Strategy, You’re Worth More Than You Think You Are.

“Instead of allowing a combination of guilt and lack of accurate pricing market data to cause you to under-price and devalue your brand, consider instead pricing your practice at true market value but using ad hoc scholarships/discounts and employer funding to improve equitable access to cash healthcare.” (Eischen; 2025)

Regulatory Considerations

“Concierge practices typically charge a fee for membership in their practice, which generally allows patients increased access to the physicians and their services. If the practice is accepting Medicare and/or commercial insurance, the fee cannot be charged for any service already covered by Medicare or insurance. Additionally, if the practice accepts commercial insurance, the fee must be scrutinized to be sure it is allowed under any agreement with a commercial payor of the practice. Some payor agreements may specifically prohibit any patient fee for membership in a practice. Some practices have reached out to their commercial payors directly when converting to a concierge practice and have had these commercial payors review and approve their patient agreements and membership fees.” (Eimer; 2025)

When you have a heart for your community, you don’t have to compete on price.

“Consider your practice pricing as establishing your perceived brand value in the marketplace. You need not track the national franchise-style concierge enterprise pricing or DPC pricing: both are frequently published, but, most cash practices do not market their prices—so the actual market is much higher than your online search reveals. So the easiest prices to find are not necessarily reflective of the actual market, and imitating them will devalue your perceived brand. Instead, work with an experienced attorney or consultant who actually knows the unpublished typical prices for cash practice models. And remember, most if not all of those published price versions of cash healthcare are not structuring their fees/services to allow for employer/tax-advantaged funding, and perhaps their lower prices are unintentionally reflecting that. Pre-tax and employer funding options allow for higher prices points, and can be used to provide versions of this care with 100% employer funding—that can enable more folks to benefit from this care model.” (Eischen; 2025)

Sales to Third Parties

“Physician owners in a concierge practice also need to consider at the formation of a practice how the profits of the practice will be divided in the case of a sale to a third party. Will profits be divided based on a physician’s ownership in the practice or based on an individual physician’s production and fee generation? If a practice has providers with vastly different production and patient panel sizes, then this is important to consider because the higher producing partner may want a sale to a third party to take into account these differences. Another partner may feel strongly that profits should be divided based on ownership percentages in the practice entity, which may be equal even if the providers have different numbers of patients. Frequently, the potential buyer has their own considerations for valuing the practices and may ascribe different values to each physician’s practice. The buyer may base its valuation of the practice on patient panel size and fees generated by each individual physician.” (Eimer; 2025)

you have options without creating compliance risks.

“If your attorney or consultant tells you that you cannot bill insurance or stay in network while doing cash heallthcare— you are not working with the right expert. There is a wide range of preference with plan billing in cash healthcare. The right expert can explain to you that you can elect to bill plans a little, a lot, or not at all, and why you have those options without creating compliance risks. You can do zero plan billing, or some, but you should know why you have those options, and why there is no need to opt out of Medicare.” (Eischen; 2025)