1. Convert an existing panel, or start fresh?
Most concierge practices are conversions: a physician with an established panel invites some of those patients to join a smaller membership practice. The other route is to open from nothing, with no panel and no legacy. The two have very different first years.
| Converting a panel | Starting fresh | |
|---|---|---|
| Members on day one | Some of your existing patients, if they join | None; every member is new |
| Cash flow in year one | Faster, if enough patients convert | Slower; growth depends on marketing and referrals |
| The hard part | Telling the patients who do not join, and helping them find care | Building a panel from zero |
| Insurance | You may keep billing insurance through the transition | You choose the model from the start |
| Records | Moving years of charts from your current system | A clean start, with intake from scratch |
| Obligations to departing patients | Notice and transfer of care; check your state and any employer contract | Usually none |
If you are converting, the departing patients are the part to plan most carefully, both ethically and legally. Give clear notice, help them find another physician, and send records promptly when asked. If you are leaving a group or a health system, read your employment contract for non-compete and non-solicitation terms before you tell a single patient. On moving the charts, see how to switch EHRs without losing patient data.
2. Setting the membership fee and what it includes
The fee has to be justified by what the member gets that they cannot get elsewhere, and it has to cover your costs at a panel size you can actually reach. Commonly reported concierge retainers run from roughly $1,500 to several thousand dollars a year per adult, with premium programs higher. Treat that as a wide market range rather than a target; the right number depends on your area, your panel and what is included.
| Commonly included | Commonly extra | Decide in writing |
|---|---|---|
| An extended annual physical | Imaging and specialist care | How quickly members can expect a reply |
| Same-day or next-day appointments | Procedures beyond the office basics | Who covers when you are away |
| Longer visits | Most outside lab work, unless you bundle it | What happens on a visit beyond the allowance |
| Direct messaging and telehealth | Hospital and emergency care | Refund terms if a member leaves mid-year |
| Care coordination and referrals | Anything the agreement does not list | Family pricing and dependents |
Two structural choices sit alongside the price. Billing cycle: annual retainers are common in concierge medicine, but monthly or quarterly billing lowers the barrier to joining. Family plans: one charge for a household, with each member keeping their own chart. Both need to be settled before you open, because the software and the agreement have to match. Membership programs for clinics covers plan design generally, and concierge medicine membership billing covers the billing mechanics.
3. Panel size, and the arithmetic behind it
Concierge panels are small by design. Commonly reported concierge panels run roughly 300 to 600 members per physician, against the thousands typical of a conventional primary care panel. The small panel is the product: it is what makes same-day access and long visits possible.
The arithmetic below is illustrative, not a forecast. It shows gross membership revenue only, before staff, rent, insurance, software and everything else in what it costs to open a cash-pay clinic.
| Members | At $1,800 a year | At $2,500 a year | At $3,500 a year |
|---|---|---|---|
| 150 | $270,000 | $375,000 | $525,000 |
| 300 | $540,000 | $750,000 | $1,050,000 |
| 450 | $810,000 | $1,125,000 | $1,575,000 |
| 600 | $1,080,000 | $1,500,000 | $2,100,000 |
Two things fall out of it. The panel you can reach in year one matters more than the panel you eventually want, so model the first twelve months at a conservative membership count. And a practice that also bills insurance for covered visits adds that revenue on top, along with the cost and administrative work of billing it.
4. Legal and contract basics, in outline
None of this is legal advice. It is the list of questions to bring to a healthcare attorney before you sign a lease or send a single invitation letter.
| Topic | What to ask about |
|---|---|
| Medicare, if you stay enrolled | The HHS Office of Inspector General has warned that charging Medicare patients a fee simply for access to services Medicare already covers can count as double billing. Retainers are generally built around services Medicare does not cover. Have an attorney review exactly what yours covers. |
| Medicare, if you opt out | Under CMS rules, a physician who opts out signs private contracts with Medicare patients, who then pay you directly. Opt-out periods run two years and now renew automatically unless canceled in writing ahead of the next period. Check the current CMS rules before deciding. |
| Commercial insurance contracts | Payer contracts may limit what you can charge members on top. Read each contract you plan to keep. |
| State law | States treat retainer and membership arrangements differently, and in some the structure can raise insurance-law questions. Check your state’s rules. |
| The membership agreement | What is included, response times, coverage, renewal, cancellation and refunds, written in plain language. |
| HSAs and tax treatment | From 2026 the IRS treats certain direct primary care fees more favorably for HSAs, within monthly limits. Whether a concierge retainer qualifies is a question for a tax advisor. |
Two practical points. Membership agreements should be signed before the first charge, and the signed copy should live on the patient’s chart. And whichever Medicare route you choose, the software has to match it: a practice that stays enrolled needs claims, while one that opts out does not. Concierge medicine vs direct primary care sets out how each model changes the regulatory picture and the software.
5. The software stack on day one
A new concierge practice needs fewer tools than it is sold, but the ones it needs have to work together. The usual mistake is a separate tool for each job, stitched together and reconciled by hand.
| Job | Needed on day one? | Notes |
|---|---|---|
| Charting, scheduling and e-consents | Yes | Including the signed membership agreement on the chart |
| Membership billing | Yes | Annual, quarterly or monthly cycles; included services counted |
| Secure patient messaging | Yes | Access is the product; keep it off personal phones |
| e-Prescribing | Yes, for a physician practice | Controlled substances need extra identity setup before go-live |
| Telehealth | Usually | Short follow-ups rarely need a room |
| Lab ordering and results | Yes | Your lab account is separate from your EMR; see below |
| Insurance billing | Only if you will bill | Payer enrollment takes weeks; start early |
| A website and a branded app | A website, yes; a white-label app, later | The app is a growth decision, not a launch one |
On Aminova specifically: the Prescribing plan is $99 a month for the first three months for new clinics billed monthly, with one AI scribe seat included, then $199 a month, plus $99 a month for each extra prescriber and a $250 one-time activation that covers e-prescribing setup and moving your data. Your plan starts when you go live, your whole team is included, and it is month-to-month. Memberships, messaging, telehealth, e-prescribing and lab ordering are in the plan. Labs are not connected to any lab electronically: orders print as requisitions and results are uploaded or entered by your team. Insurance billing is an add-on priced on claim volume; a website is $99 a month; a white-label app is $750 once and $79 a month. For the full EMR bill, see what a concierge medicine EMR costs and the year-one total.
6. A realistic timeline
Plan on three to six months from decision to first member, and longer if you are leaving an employer or need payer enrollment. The steps below run partly in parallel; how long it takes to open a cash-pay clinic covers the lead times in detail.
| When | What happens |
|---|---|
| Months 1–2 | Attorney review of contracts, Medicare route and state rules; fee and plan design; entity and banking |
| Months 2–3 | Software chosen and configured; membership agreement drafted; records migration planned |
| Months 2–4 | Payer enrollment, if you will bill insurance; e-prescribing identity setup |
| Months 3–4 | Invitation letters to your existing panel, if converting; website live |
| Months 4–6 | First members enrolled and billed; departing patients helped to transfer |
The date most often moves for the same three reasons: an employment contract that restricts what you can tell patients, payer enrollment that takes longer than planned, and conversion that comes in slower than modeled. Build the plan so that the practice can open on a conservative member count, and treat anything above it as upside.
7. Frequently asked questions
How much does it cost to start a concierge medicine practice?
It depends mostly on space, staff and whether you are converting a panel. Software is a small line: Aminova’s Prescribing plan is $199 a month after a $99 intro for the first three months, plus a $250 activation. What it costs to open a cash-pay clinic covers the rest.
How many patients does a concierge doctor have?
Commonly reported concierge panels run roughly 300 to 600 members per physician, far smaller than a conventional primary care panel. The small panel is what makes same-day access possible.
How much should I charge for a concierge membership?
Commonly reported retainers run from roughly $1,500 to several thousand dollars a year per adult. Set yours from what you include, your local market, and the panel size you can realistically reach in year one.
Can a concierge practice accept Medicare?
Many do, but the HHS Office of Inspector General has warned against charging Medicare patients a fee only for access to covered services. Some physicians opt out of Medicare instead. Both routes have rules a healthcare attorney should review.
How long does it take to open a concierge practice?
Commonly three to six months from decision to first member, longer if you are leaving an employer or need insurance payer enrollment. Contract review and patient notice usually set the pace.