Setting up a concierge medical practice involves choosing a business model, restructuring your patient panel, handling legal and insurance requirements, and building the operational infrastructure to support a membership-based practice. Most physicians move through this process over several months, and the decisions you make early, particularly around pricing and insurance participation, shape everything that follows.
Choose Your Practice Model First
Three distinct models fall under the “concierge” umbrella, and they differ in meaningful ways. A full concierge practice continues to accept insurance but charges patients an additional annual membership fee for enhanced access and premium services. Panel sizes are small, typically 200 to 300 patients per physician, and the focus is on a high-touch experience: longer appointments, same-day or next-day availability, direct physician cell phone access, and extras like vascular screenings or executive lab panels. Annual fees generally range from $1,500 to $1,700, though some luxury practices charge well above that.
A direct primary care (DPC) practice takes a different approach. You don’t accept insurance at all. Patients pay a monthly fee, usually under $100, that covers most primary care services including labs, basic procedures, and sometimes medications. Because the per-patient revenue is lower, DPC panels run larger, between 400 and 800 patients. The tradeoff is dramatically lower administrative overhead since you’re not filing claims or negotiating with payers. As one DPC advocate puts it, the model is “so simple even a doctor can run it.”
A hybrid model splits the difference. You maintain some insurance-based patients alongside a concierge or DPC panel. This can ease the financial transition, but it adds complexity to scheduling, billing, and workflow since you’re essentially running two practices under one roof.
Run the Financial Numbers Early
Starting any medical practice typically costs between $70,000 and $100,000 or more. For a concierge conversion from an existing practice, some of those costs are lower since you already have equipment and a location. But you’ll face new expenses: legal fees for membership agreements, updated technology, marketing to attract and retain patients, and a financial runway to cover the gap while your panel fills.
The critical calculation is your break-even patient count. If you’re charging $1,700 per year and your overhead (rent, staff, malpractice, supplies) runs $300,000 annually, you need roughly 175 paying members just to cover costs before your own salary. A full concierge model with 250 to 300 patients at that fee level generates $425,000 to $510,000 in membership revenue alone, plus whatever you collect from insurance billing on covered services. For DPC at $75 per month, you’d need a larger panel to hit the same numbers, but your staffing and billing costs will be significantly lower.
Build a ramp-up plan that accounts for gradual enrollment. Very few practices launch at full capacity. Budget for at least six to twelve months of reduced revenue during the transition period, and be conservative in your projections.
Understand the Legal Requirements
Your membership agreement is the legal backbone of a concierge practice, and getting it right matters. At minimum, it needs to clearly define what the membership fee covers and, just as importantly, what it does not. The membership fee pays for enhanced access and amenities. It does not pay for professional medical services covered by insurance. Your agreement should state explicitly that it is a service contract, not a contract of insurance, and that patients agree not to submit the membership fee to their health insurer for reimbursement.
Standard contract terms include a one-year initial term with automatic annual renewal, a 30-day written termination clause for either party, and a prorated refund policy if the patient leaves early (minus a reasonable administrative fee, often around $200). Have a healthcare attorney draft or review your agreement rather than adapting a template you found online. State laws on membership medicine vary, and some states have specific registration or disclosure requirements for these practice models.
Medicare Patients Need Special Attention
If you see Medicare patients and want to continue doing so, the rules are strict. Physicians who accept Medicare assignment cannot charge patients extra for Medicare-covered services. Your membership fee can only cover services and amenities that Medicare doesn’t pay for. You must provide patients with a written notice listing any services that Medicare may not cover and explaining why. Physicians who don’t accept assignment can charge up to 15% above the Medicare-approved amount, but no more.
The alternative is formally opting out of Medicare entirely, which requires filing an affidavit and signing private contracts with each Medicare-eligible patient. This is a two-year commitment, and it means none of your services for those patients can be billed to Medicare during that period. For many concierge physicians, especially those in communities with a large retirement-age population, navigating Medicare rules rather than opting out entirely is the more practical path.
Restructure Your Patient Panel
A traditional primary care physician carries a panel of 2,000 or more patients. A concierge practice drops that to 400 to 600 patients, and sometimes fewer than 300 for a premium model. That means the majority of your current patients will not follow you into the new model. This is the hardest part of the transition for most physicians, both logistically and emotionally.
Start by identifying patients who are most likely to value and afford the membership. Look at your existing panel for patients who already request longer visits, who have complex care needs, or who have expressed frustration with access and wait times. Give your full panel ample written notice of the transition, typically 90 days or more. Provide referrals to other physicians for patients who choose not to join, and document everything. Your state medical board likely has specific requirements for how patient notification and transfer of care must be handled.
Set Up Your Operations and Technology
The operational shift in a concierge practice is significant. You’ll need systems for recurring membership billing, which is different from insurance claims processing. Most practices use a combination of a standard electronic health records system and a separate membership management platform that handles automated monthly or annual payments, patient communication, and contract tracking. Look for an EHR that supports a patient portal with secure messaging, since direct physician access is a core part of the concierge value proposition.
Staffing looks different too. You’ll likely need fewer billing and coding staff (or none, in a DPC model) but may want a dedicated patient coordinator who manages the membership experience: scheduling, follow-ups, specialist referrals, and the kind of white-glove service your members are paying for. Initial technology setup costs average around $5,000, with ongoing monthly costs of roughly $700 for your software stack.
Plan the Transition Timeline
Most concierge practice launches follow four phases. The first is vision and feasibility: deciding on your model, researching your market, and determining whether your community can support a membership practice at your target price point. The second phase is financial modeling, where you set your fee, calculate your break-even panel size, and build your ramp-up budget. Phase three covers operational design, including staffing plans, workflows, office hours, technology selection, and your membership agreement. The fourth phase is the actual transition or launch, followed by a period of early optimization as you adjust based on what’s working.
From initial planning to accepting your first member, expect the process to take four to eight months for a conversion from an existing practice. A ground-up startup takes longer, since you’re also securing a location, credentialing, and building a patient base from scratch. Don’t rush the patient notification period. Giving your current patients enough time and clear communication about the change protects both your reputation and your legal standing.
Price Your Membership Strategically
Pricing is where many new concierge physicians second-guess themselves. Fees across the industry range enormously, from $60 per year on the low end to $15,000 per year for ultra-premium practices, but the bulk of concierge practices land between $1,500 and $2,000 annually. DPC practices typically charge $50 to $100 per month.
Your fee should reflect your local market, the services included, and your target panel size. A lower fee means you need more patients to sustain the practice. A higher fee gives you more revenue per patient but narrows your potential market and increases the pressure to deliver a genuinely premium experience. Research what other concierge and DPC practices in your area charge. If you’re the first in your market, look at comparable metro areas and adjust for local cost of living. Consider offering tiered pricing, such as individual, couple, and family memberships, to broaden your appeal without undercutting your per-patient revenue.
One common mistake is underpricing out of guilt or fear of losing patients. Remember that the entire premise of concierge medicine is that smaller panels and better access create better outcomes. Your fee funds that model. If it’s too low to sustain a small panel, you’ll end up with the same time pressure and access problems your patients are paying to escape.