How to start or transition to a concierge medicine practice

To transition to concierge medicine, you make three decisions before a single patient hears about it: the model, the fee and your Medicare status. Then you tell everyone the same thing, in writing, with enough time to find another doctor if they don't join.

Get that order wrong and you end up rewriting the letter after patients have already read it. This guide covers the order, the rules that shape the message, and what to say.

Settle the model before anyone hears about it

Decide two things: whether this is concierge medicine or direct primary care, and whether you convert fully or run a hybrid. Each answer changes the message.

The AAFP's policy on direct primary care describes patients paying the practice directly, in periodic payments, for a defined set of primary care services, with that fee typically replacing fee-for-service billing to insurance. If that's your model and you stop billing insurance for that care, the message has to say so, and explain that patients still need their own coverage for anything outside it.

Then choose how you roll it out:

• Full conversion. Every patient either joins or moves on. The simplest message, and the most patients who will need notice.
• Hybrid. Members get the membership; everyone else stays on the current model. You explain two tiers without making one sound second-rate, and if you see Medicare patients, the route in the next section decides whether non-members can stay as they are.

The same decisions apply if you're opening a new concierge medical practice rather than converting one. Then write down what the fee buys in concrete terms: appointment length, how patients reach the doctor, what happens after hours. If you can't list it on one page, patients won't be able to repeat it to each other.

Work out the fee from your own numbers

There is no standard fee to copy. A figure from another practice was set for its panel and its costs, not yours. Start from three numbers of your own:

1. The panel size you can care for at the access you are promising: visit length, same-day availability, how fast messages get answered.
2. Your annual practice costs plus the income you need, minus any revenue you will keep from outside the membership, such as insurance billing for non-members in a hybrid.
3. The number of members you plan for, based on your own patient list, not a published average.

The second number divided by the third gives a starting annual fee. Then check what that fee is allowed to cover under your Medicare route.

Starting a concierge practice from scratch

Opening a new concierge medical practice skips the hardest part of a transition — nobody has to be told their care is changing — and replaces it with a different problem: you have no panel to convert. The model, the fee and the Medicare route above all still apply. What changes is where the first members come from.

• The people who already know you. Former patients who can follow you, colleagues who refer, and the local network you already have. This is the first year for most new practices.
• A page that answers the whole question. The fee, what it buys, panel size, how to reach the doctor, and what happens after hours. People do not join a membership they have to phone to understand.
• A waitlist before you open. Names collected while you are still setting up tell you whether the fee lands before you are paying rent.
• Local search. "concierge doctor [city]" and "direct primary care [city]" are small in volume and high in intent. A Google Business Profile and one clear page cover most of it.
• Paid search, carefully. Useful once the page converts, because the searches are specific enough to buy. Our concierge and DPC marketing page covers how we run them.

Have three things working on the day you open: the one-page explanation of the membership, a way to book that does not require a phone call, and someone who answers the phone when people do call anyway. A membership decision is often a household conversation that takes weeks, so expect a gap between the first inquiry and the first payment, and plan the cash for it.

Concierge medicine and Medicare: staying enrolled

If you see Medicare patients, your Medicare route decides what your fee is allowed to cover. You can stay enrolled or opt out.

Medicare.gov's page on concierge care says Medicare doesn't cover membership fees, and that doctors who accept assignment can't charge extra for Medicare-covered services. So the fee can't include charges for items or services Medicare usually covers; it can cover items and services Medicare doesn't cover (checked 15 September 2026). If Medicare won't pay for something it usually covers, the page says you must give the patient a written Advance Beneficiary Notice of Noncoverage listing the services and why Medicare may not pay. If you don't accept assignment, you can charge more than the Medicare-approved amount for covered services, but only up to a 15% limit called the "limiting charge"; ask your attorney how that affects your fee.

The HHS Office of Inspector General's 2004 alert on added charges describes a physician who asked patients for a $600 annual fee for things like care coordination and extra time. The OIG alleged some of that was already covered by Medicare, and the physician agreed to pay a settlement and stop offering the contracts. The alert also warns that non-participating doctors can face penalties for overcharging for covered services.

Opting out of Medicare

CMS's enrollment guidance says opting out means filing a signed affidavit and entering a private contract with each Medicare patient, agreeing that they pay out of pocket and nobody bills Medicare. Those contracts can't be signed with patients who need emergency or urgent care (checked 15 September 2026).

You can't opt out for some Medicare patients and not others. That includes Medicare patients who don't join, so opting out doesn't fit a hybrid model that keeps billing Medicare for non-members. The status renews every two years on its own, and cancelling means writing to your Medicare Administrative Contractor at least 30 days before the period ends.

Know exactly who you're telling

Your practice management export is not a mailing list. Before anything is sent:

• Decide who counts as a current patient for this letter, and agree that definition with your attorney.
• Remove duplicates, people who have moved away or died, and anyone who asked not to be contacted.
• Use the contact details and channels each patient already gave you.
• Brief your staff first, so they aren't learning the news from patients at the front desk.

On privacy: the HIPAA Privacy Rule's definition of marketing in 45 CFR 164.501 excludes communications that describe a health-related service your own practice provides, unless you are paid by a third party whose product or service the message describes. Ask your attorney how that applies to your plan. Either way, a letter about membership never needs to mention anyone's care, so keep health details out of it.

Give written notice, and more time than the minimum

A patient who doesn't join is losing their doctor, so check what your state medical board expects before you end anyone's care.

The Oregon Medical Board's guidance on ending the provider-patient relationship is one example. It says a licensee must give written notice at least 30 days in advance, should point the patient to resources for finding a new provider, and must ensure the patient has access to their medical records; the notice should explain how to get or transfer them (checked 15 September 2026).

If your board sets a minimum, treat it as a floor. A membership is often a household decision, and a notice window that only just clears the rule leaves no room for questions, a reminder or a conversation with the doctor. If you're in a group or employed, check your contract too.

What the letter to patients should say

One letter, signed by the doctor, sent to every patient on the list at the same time. It should answer these questions, in this order:

1. What is changing, and the date it takes effect.
2. Why, in a sentence or two, in the doctor's own words.
3. The fee, how it's paid, what it includes and what it doesn't, including whether insurance or Medicare is still billed.
4. How to join, and the date to decide by.
5. What happens if they don't join: when care from the practice ends, how to get records, and a list of nearby practices.
6. Who to call or email with questions.

Describe access and time, not better health. Don't promise outcomes, and don't push. A patient who feels cornered tells their neighbours about it.

Put the fee and the terms on one page

The letter gets forwarded to a spouse, read on a phone and argued over at dinner. Give it a page on your website to point to: the fee, what it covers and doesn't, how insurance and Medicare fit, cancellation terms, how to join, and a short FAQ.

Two federal rules can reach that page. If patients pay you directly, without a claim going to their plan, ask your attorney whether the Good Faith Estimate rules apply to your fee. If members sign up online for a membership that renews and bills automatically, the federal rules on recurring online billing apply. Our guide to pricing pages covers both.

That FAQ should answer the questions patients ask next. Is any of the fee refunded if they leave mid-term? Who covers when the doctor is away? In a hybrid model, how do non-members book?

Let people book a call with the practice from that page, instead of asking them to phone during office hours. How we build booking pages covers what that takes. If your model is direct primary care, ask your attorney whether your state has rules for DPC agreements.

Follow up, then stop

Letters get set aside. A plan needs more than one contact:

• An email version of the letter a few days later, with a link to the page.
• One phone line and one inbox for questions, with a short written script so staff give one consistent answer.
• A reminder before the decision date, and one more before care ends for anyone who hasn't chosen.
• A simple record of who joined, who declined and who hasn't answered.

Once someone declines, stop the membership messages and switch to helping them move. The same approach runs our patient reactivation campaigns: a clean list, a real reason to write, and a stop when someone says no.

Plan for the patients who don't join

Many of your patients may not follow you. In a 2020 article in the AAFP's journal Family Practice Management on transitioning to direct primary care, a family physician wrote that most physicians convert only about 10% of their patients initially. That's one account of DPC, not a forecast for your practice. Build the plan, and the budget, on the assumption that plenty of patients will say no.

For those who leave, the work is practical. Send records promptly when asked, keep the list of nearby practices current, and keep caring for them through the notice period you set. How you treat them is how the rest of the town hears about the change.

Mistakes that derail a transition to concierge medicine

• Announcing the change before the Medicare route and the agreement are settled.
• Telling a few favorite patients early, so everyone else hears it second-hand.
• A fee that quietly includes services Medicare already covers.
• Selling the membership as better medicine rather than more time and access.
• No list of other practices, and no phone line, for patients who decline.
• Starting ads for new members before existing patients have been told.

Once existing patients have made their choice, finding members for the places left is slow, local work. Our concierge medicine and DPC marketing page explains how we run the ads, pages and follow-up for that, from your own accounts.

Sources

• Medicare.gov — Concierge care, checked 15 September 2026
• HHS Office of Inspector General — OIG alerts physicians about added charges for covered services (31 March 2004), checked 15 September 2026
• CMS — Manage your enrollment (opting out of Medicare), checked 15 September 2026
• eCFR — 45 CFR 164.501, Definitions, checked 15 September 2026
• American Academy of Family Physicians — Direct primary care policy, checked 15 September 2026
• Oregon Medical Board — Ending the provider-patient relationship, checked 15 September 2026
• Family Practice Management — Transitioning to direct primary care (July/August 2020), checked 15 September 2026