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Raising Your Membership Fee: When, How Much and How to Tell Patients
Staff pay and practice costs keep climbing while many concierge fees sit unchanged for years. This brief lays out the current federal cost data, what research says about how people judge a price increase, the ethical and notice duties that come with one, and a calculator that shows how many members you can lose before an increase stops paying for itself.
New in October 2026. Cost figures reflect federal data released through September 2026.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
Federal data show health care compensation up 3.8% in the year to June 2026, and CMS projected practice costs (the Medicare Economic Index) to rise 2.7% in 2026, while the Medicare conversion factor sits in 2026 almost exactly where it was in 2024. A concierge fee left flat for several years therefore loses real value. An increase tied to documented costs is the kind people judge fair in the best-known research on pricing, and the arithmetic usually forgives some attrition: a 10% increase still breaks even if fewer than about 9% of members leave because of it. Members deserve long notice and a plain reason. Anyone who decides not to renew deserves real help finding care.
Is it reasonable to raise my fee this year?
If your fee has not moved in two or more years, federal data suggest your costs have. Health care compensation rose 3.8% in the year to June 2026 and CMS projected practice costs to rise 2.7% in 2026.
Go to the full answer ↓How large an increase do patients accept?
No public concierge data answer this. Classic fairness research found most people accept increases that pass on higher costs and reject ones that exploit demand, so tie the size to your costs and say so.
Go to the full answer ↓How many members can I lose before an increase stops paying?
For a 10% increase, fewer than about 9.1% of members. The break-even share is the increase divided by one plus the increase. The calculator in Part 3 runs your own numbers.
Go to the full answer ↓How much notice do patients need?
Read your membership agreement first, then state law; California, for one, sets a 7 to 30 day notice window for fee changes on automatically renewing contracts. CMT suggests 60 to 90 days before renewal as a courtesy floor, but that is editorial guidance, not a legal rule.
Go to the full answer ↓What should the letter say?
The new fee, the date, the reason in plain terms, what stays the same, and how to leave with help. Part 5 has a step-by-step outline.
Go to the full answer ↓What a flat fee costs you
A membership fee is a promise priced in a given year. Payroll and malpractice premiums renew on their own schedules, and they rarely go down.
Start with staff pay. The federal data are plain. Compensation for private health care and social assistance workers rose 3.8% in the twelve months to June 2026, faster than the 3.3% for private industry overall.1,
Most concierge practices still bill insurance, so Medicare rates matter to them alongside the fee. Those rates have gone sideways. The conversion factor fell 2.83% in 2025, recovered in 2026 with help from a one-year 2.5% increase in federal law, and is proposed to drop again in 2027 when that increase expires.4,
Conversion factor $33.29, the baseline CMS used for 2025.4
$32.35, a cut of 2.83%.4
$33.40 for most physicians (nonqualifying APM) and $33.57 for qualifying APM participants, increases of 3.26% and 3.77%, including a one-year 2.5% statutory boost.5,
$32.84 nonqualifying and $33.17 qualifying, cuts of 1.68% and 1.19%, as the one-year boost ends. Final rule pending.7
Start with physician time. If costs rise about 3% a year and the fee does not move, the practice must either see more members or spend less time with each one. Both erode the reason members joined. CMT’s reading: a fee that never changes is a decision, too, and usually an unexamined one.
What your members are paying for everything else
Members read a fee letter against their own budget. Many concierge members are on Medicare, and in 2026 their Part B premium rose much faster than their Social Security check.
Two readings follow. Prices for physicians’ services rose 2.0%, more slowly than prices overall, so members are not seeing big jumps from doctors elsewhere and a large concierge increase will stand out. And a retiree whose benefit rose 2.8% while Part B rose $17.90 a month will notice a double-digit increase.8,
Why the reason matters
In a classic set of telephone surveys published in the American Economic Review, 79% of respondents said a grocer passing on a higher wholesale cost was acceptable. When a hardware store raised snow shovel prices the morning after a blizzard, 82% called it unfair.12 Practice Insight
The lesson the authors drew: people accept increases that protect a seller’s margin against higher costs and resent ones that exploit demand. The samples were Canadian adults in the 1980s and the products were not medical, so treat it as a guide to framing, not a forecast.
Why notice prompts decisions
An NBER working paper using payment card data on monthly subscriptions found that many subscribers who had to act to keep a subscription, after a card was replaced, did not renew. The authors estimate that inattention raises subscription revenue by anywhere from 14% to more than 200%, depending on the product.13 Population Data
The paper is not peer reviewed and did not study medicine. Its relevance here is simple: a fee letter asks every member to think about the membership again. Some quiet members will leave. That is a cost to plan for, not to avoid by staying vague.
Run the numbers before you write the letter
Every increase carries a break-even point: the share of members who can leave before revenue falls below where it started. It equals the increase divided by one plus the increase. A 5% increase breaks even at about 4.8% attrition, 10% at about 9.1%, 15% at about 13.0% and 20% at about 16.7%. That is arithmetic, not evidence about how patients behave.
Brief No. 29 explains why there is still no public concierge fee benchmark, so this tool starts from your own fee, not a market average.
Fee-increase calculator
| If this share leaves | Members after | Membership revenue | Change vs. today |
|---|
Models membership fee revenue only. It ignores insurance revenue, refunds, taxes, waitlist replacement and the physician time freed when members leave. A planning aid, not financial advice.
Two cautions on using the output. First, attrition is not only lost revenue: a smaller panel can mean more time per member, and a waitlist can refill it. Second, a large increase after years of none is harder to explain than a smaller, regular one. CMT’s editorial view, not a research finding, is that a predictable schedule tied to published cost data is easier on trust than an occasional jump.
What ethics and law ask when the fee changes
A fee increase is a smaller event than a conversion, but some of the same duties apply. These are general points for a conversation with counsel. Rules vary by state, and none of this is legal advice.
The AMA’s opinion on retainer practices asks physicians to explain the arrangement clearly, including its effect on insurance, and to keep retainer charges separate from services insurance covers. Patients must be free to decline.14
The same opinion asks physicians to help patients who decline a retainer contract transfer to another physician, and to keep treating them under existing insurance if no local transfer is feasible.14 The AMA’s separate opinion on ending a relationship asks for notice “long enough in advance to permit the patient to secure another physician.”15 CMT’s reading: a member who leaves over price deserves the same transition help as one who leaves at conversion.
Most membership agreements state the term, the renewal date and how fees can change. An increase that takes effect mid-term, or without the notice the agreement promises, invites disputes. Have counsel read the clause before you set a date.
California requires businesses with automatically renewing contracts to give clear and conspicuous notice of a fee change no less than 7 and no more than 30 days before it takes effect, with retainable cancellation instructions.16 The amendments apply to contracts entered, amended or extended on or after July 1, 2025.17 Other states have their own versions. Whether one reaches your agreement is a question for counsel.
If the increase comes with new services, check that none are already covered by Medicare. In 2004 federal regulators warned that charging Medicare patients for covered services, such as coordination of care, can bring substantial penalties and exclusion.18 Brief No. 43 covers payer contracts.
An outline for the fee letter
Members should hear about an increase from the practice, in writing, before they hear it from each other. This outline is CMT’s editorial guidance, built from the ethics points in Part 4 and the fairness research in Part 2. Adapt it with counsel.
Decide the timeline first
Pick the renewal date the increase applies to, then count back. CMT suggests at least 60 to 90 days of notice before renewal, more than many contracts require. Check any statutory window, such as California’s.
Open with the relationship
Start with what the membership has meant for care this year in concrete terms, such as same-day visits or longer appointments. Two sentences, no marketing language.
State the change plainly
Give the current fee, the new fee and the date in one sentence, in dollars. Do not bury the number.
Give the real reason
Name the costs that moved, such as staff pay or malpractice premiums, and how long the fee has been flat. If you cite a public figure, cite it accurately.
Say what stays the same
Your panel limit and your access commitments. If anything is changing in services, say exactly what.
Offer options where you can
Some practices offer monthly payments or a hardship review. Only offer what you will apply consistently.
Make leaving easy and safe
Explain how to decline renewal, how records transfer and how the practice will help find another physician. Name a staff contact.
Follow up in person
Train staff on the reason and the facts. Have the physician call members with complex needs, who stand to lose the most from a change.
CMT survey data on how often concierge practices raise fees, the typical size of an increase, the notice period used and renewal rates in the year after an increase, reported separately for concierge and DPC respondents, with sample size, dates and recruitment method.
Editor: replace this box with CMT survey results (with sample size, dates and recruitment method) before publishing, or delete it.
Know your cost curve
Track your own cost growth each year against the federal series in Part 1, so the number in your letter is yours.
Build a schedule
Set a review date and a rule for when the fee changes. Put the notice period in your agreement.
Lead with candor
Tell members early and plainly, and help anyone who leaves find care. That protects trust in the whole field.
How this brief was built
CMT gathered cost and payment data from primary federal sources: the Bureau of Labor Statistics Consumer Price Index (August 2026) and Employment Cost Index (June 2026), CMS physician fee schedule fact sheets from 2025 through the 2027 proposed rule, the CMS Medicare premium notice and the Social Security COLA announcement. The 2026 Medicare Economic Index projection comes from the AMA’s report of CMS’s figure, because the CMS fact sheet does not state it. Pricing research was limited to one peer-reviewed study and one NBER working paper, labeled as not peer reviewed. Ethics and notice material comes from two AMA Code of Medical Ethics opinions, a 2004 HHS OIG alert, a California statute and a law firm summary of it, all opened in October 2026.
All fee examples in this brief are illustrations, not benchmarks. CMT Research Brief No. 29 covers what is and is not known about concierge fee levels; this brief does not repeat those figures. No direct primary care data are used. The calculator is a planning aid that models membership revenue only; it is not financial, legal or tax advice.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How often concierge practices raise fees, and by how much. CMT found no published, methodology-disclosed data.
- How many members leave after an increase. No peer-reviewed study of concierge renewal rates after a fee change was found.
- Whether price fairness findings from consumer goods hold for a long physician relationship, where trust and switching costs differ.
- Which state automatic renewal laws reach physician membership agreements. That depends on the agreement and the state, and needs counsel.
- The final 2027 conversion factor, which CMS will set in its final rule.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- U.S. Bureau of Labor Statistics. Employment Cost Index news release, Table 5: Employment Cost Index for total compensation, for private industry workers, by occupational group and industry (not seasonally adjusted), June 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
- U.S. Bureau of Labor Statistics. Employment Cost Index, June 2026 (news release). July 31, 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
- O'Reilly KB. Physicians will see Medicare payments rise in 2026. American Medical Association. July 21, 2025. www.ama-assn.orgFunding: not stated (published by the American Medical Association, a physician advocacy organization)
- Centers for Medicare & Medicaid Services. Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule (fact sheet). November 1, 2024. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F) (fact sheet). October 31, 2025. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- American Medical Association. Medicare updates compared to inflation in practice costs (2001 to 2025) (chart; sources: Federal Register, Medicare Trustees' Reports, Bureau of Labor Statistics, Congressional Budget Office). Updated January 2025. ama-assn.orgFunding: not stated (published by the American Medical Association, a physician advocacy organization)
- Centers for Medicare & Medicaid Services. Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (fact sheet). July 14, 2026. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B premiums and deductibles (fact sheet). November 14, 2025. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Social Security Administration. Social Security announces 2.8 percent benefit increase for 2026 (press release). October 24, 2025. www.ssa.govFunding: federal (Social Security Administration publication)
- U.S. Bureau of Labor Statistics. Consumer Price Index, August 2026 (news release USDL, CPI). September 11, 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
- U.S. Bureau of Labor Statistics. Consumer Price Index news release, Table 2: CPI for All Urban Consumers (CPI-U), U.S. city average, by detailed expenditure category, August 2026. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
- Kahneman D, Knetsch JL, Thaler R. Fairness as a constraint on profit seeking: entitlements in the market. American Economic Review. 1986;76(4):728-741. eml.berkeley.eduFunding: mixed: Department of Fisheries and Oceans Canada; U.S. Office of Naval Research (Kahneman); Alfred P. Sloan Foundation (Thaler), per the paper
- Einav L, Klopack B, Mahoney N. Selling subscriptions. NBER Working Paper 31547. August 2023 (not peer reviewed). Summary via NBER Digest, October 2023. www.nber.orgFunding: not stated (no funder named in the working paper; data from an unnamed U.S. payment card network)
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- American Medical Association. Code of Medical Ethics Opinion 1.1.5: Terminating a Patient-Physician Relationship. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- California Business and Professions Code, section 17602 (automatic renewal and continuous service offers), as amended by Stats. 2024, ch. 515 (AB 2863). 2025 California Code via Justia. law.justia.comFunding: not stated (state statute)
- Floyd M, Wu Min XD. California's latest automatic renewal law amendments take effect in July 2025. Kilpatrick Townsend & Stockton LLP. October 3, 2024. Law firm commentary. ktslaw.comFunding: not stated (law firm analysis)
- HHS Office of Inspector General. OIG Alert: charging Medicare beneficiaries for services that are covered (assignment violations). March 31, 2004. hhs.govFunding: federal (HHS Office of Inspector General publication)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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