Concierge Medicine: Is It Right for You? (Part Two: The Operational Reality)

By: Matt Wilmot & Edgar Bueno

In Part One of this article series, we covered the strategic decisions that come first:

• Whether the concierge model is the right fit
• How to think about the Medicare opt-in/opt-out question
• The broad regulatory landscape

For providers moving forward with a concierge or direct care model, the focus shifts from high-level structure to the operational mechanics to ensure a compliant and legally sound practice.

Building a concierge practice involves a set of operational decisions that are just as critical as the strategic ones. How will you deliver care? How will you price it? And what documentation and contracts do you need to protect yourself, your patients, and your practice?

Advanced Practice Providers: NPs and PAs

NPs and PAs (jointly, Advanced Practice Providers or “APPs”) can participate in a concierge model, but there are specific considerations that apply to them which are worth addressing before you build your practice structure around them.

Scope of practice is the starting point. APPs have specific requirements as to what services they can independently provide and when physician supervision is required. This is not necessarily a barrier, but it needs to be mapped out very clearly.

Ownership and supervision are also worth flagging. In many states, APPs are restricted from employing or supervising physicians, which can create real complications for an APP seeking direct ownership of a concierge practice.

In Georgia specifically, if an APP wants to provide services beyond their basic duties, including prescribing drugs or ordering diagnostic studies, they must maintain a collaboration agreement with a licensed physician, approved by the Georgia Composite Medical Board. These agreements are a critical part of the compliance structure for APP-led practices and need to be in place before services begin.

Service Delivery: Telehealth and Home Visits

Many concierge practices blend in-person and virtual care, and both have distinct legal considerations. Physical house calls add a layer of logistical complexity that is also worth thinking through carefully.

Telehealth

• Licensure: You must be licensed in the state where the patient is physically located at the time of the visit.
• State Law: Each state has its own rules governing telemedicine, separate from general medical licensing.
• Prescribing Rules: Many states restrict prescribing controlled substances via telehealth without a prior in-person examination.
• HIPAA Security: All communications must be encrypted end-to-end. Standard SMS or general-purpose video platforms typically don’t meet the “covered entity” standard. You will need a compliant telehealth platform, which comes with its own cost.

Home Visits

• Insurance: House calls require a careful review of your coverage. Your existing policy may not extend beyond an office setting, and you may need broader professional liability coverage.
• Additional Documentation: Consider implementing liability waivers for injuries or damage that could occur in a patient’s home. Every home presents unknowns.
• Equipment and Supplies: Make sure you can realistically deliver the same quality of care in a home setting.
• Caregivers: If a patient is homebound or immobile, you may need a caregiver present during the visit.

Pricing Models

Concierge medicine opens up more flexibility in how you structure fees. The main options are:

• Subscription-Based: Patients pay a recurring fee for a defined set of services. This is the foundation of Direct Primary Care (DPC). In Georgia, there are specific requirements to avoid being classified as an insurance product under state law.
• The Hybrid Model: The practice bills insurance for covered visits and charges a separate membership fee for non-covered amenities. This model carries the highest risk of “double-billing” scrutiny.
• Fee-for-Service: A flat fee for each encounter. This is the most transparent approach, but lacks the predictable recurring revenue of a subscription model.

The right model will depend on which insurers you participate with, how frequently patients will use your services, your patient demographics, and the scope of what you offer. There is no single right answer, but the decision has downstream effects on compliance, cash flow, and patient experience, so it’s worth thinking through carefully.

Essential Documentation and Contracts

A concierge practice requires documentation tailored to its specific model. The following are generally important to have in place before you open your doors:

• Patient Consent: Describing the services and obtaining the patient’s agreement to be treated under the concierge model.
• Financial Agreement: Laying out payment terms, frequency, cancellation policies, and refunds.
• In-Home/Telehealth Consent: Separate consent documents specific to alternative treatment settings or modalities.
• Notice of Privacy Practices: A HIPAA-compliant document explaining how protected health information (PHI) is used, shared, and managed, along with the patient’s rights around their own information.
• EMR/Telemedicine Vendor Agreements: Contracts with vendors for electronic medical records and telehealth platforms.
• Provider Agreements: Terms of employment for health care providers, including whether they are acting as employees or independent contractors.
• Medical Director Agreements: Defining the responsibilities, authority, and scope of supervision for the medical director.
• Collaboration Agreements: Particularly for APPs, ensuring the scope of practice is clearly captured and appropriate physician oversight is in place.
• Compliance Plan and Policies: Documenting the compliance program in a manner consistent with what the Office of Inspector General (OIG) expects.

Starting a concierge practice is a real undertaking. Done right, it can be one of the most rewarding moves a health care provider makes. A thoughtful, legally grounded approach to both the strategic and operational sides is what sets practices up for long-term success rather than avoidable problems.

For guidance on launching or operating a concierge medicine practice in compliance with state and federal health care regulations, please contact Matt Wilmot, Edgar Bueno, or a member of HunterMaclean’s Health Care Compliance & Regulation practice group at (912) 236-0261.