Considering concierge? Know the legal traps first, with Ericka Adler, J.D.

More physicians are turning to concierge and hybrid concierge models to shrink their panels and steady their finances, but the move carries legal exposure that's easy to miss until it becomes a problem.

Ericka Adler, J.D., health care practice group manager at Roetzel & Andress, joins Medical Economics Managing Editor Todd Shryock to walk through the rules that trip practices up: why a membership fee has to be tied to a service insurance doesn't already cover, how Medicare and commercial contracts can quietly prohibit what a practice is planning, and what physicians have to put in writing so patients are never left feeling like they have to pay up or walk. She also lays out the planning, market research and runway it takes to make the transition actually work.

Don’t miss our recent episodes on compensation, physician pay vs. productivity, Medicare & Medicaid GLP-1 coverage and hiring.

Music Credits:
Nightfall Reverie by KBH Production - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:26 | Cold open Ericka Adler on why calling yourself a concierge practice doesn't let you cut legal corners.

0:26 – 1:33 | Introduction Austin Littrell previews the episode and the legal considerations behind concierge medicine.

1:33 – 1:53 | Meet Ericka Adler Todd Shryock introduces the guest and the topic.

1:53 – 3:07 | Choosing the right entity Why entity selection for a concierge practice is no different than for any medical practice, and how state law drives the choice.

3:07 – 5:36 | Hybrid vs. cash-only, from a legal view In a hybrid model the membership fee has to cover something insurance doesn't, and what counts as "not covered" changes year to year.

5:36 – 9:02 | What physicians overlook in the switch Proper notice, terminating contracts and why you can't force insured patients to pay a concierge fee to stay.

9:02 – 11:43 | The Medicare problem Annual physicals are covered now, 24/7 access may already be required, and old membership documents can leave you charging for things you no longer can.

11:43 – 14:12 | The patient contract What the agreement has to spell out: the fee, what it covers, proration and what happens when a patient dies, moves or leaves.

14:12 – 15:03 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listener submissions.

15:03 – 16:48 | The documents you still need Informed consent, HIPAA, financial forms and good faith estimates all still apply, no matter the specialty.

16:48 – 18:30 | Risks unique to concierge How a cash-based practice's exposure differs from a hybrid model that still bills insurance.

18:30 – 21:25 | The 24/7 access marketing trap Why "24/7 access" can't be the basis of a hybrid membership fee when most plans already require equal treatment.

21:25 – 25:29 | Planning, patients and market research Giving patients runway, avoiding abandonment and making sure your community can actually afford the fee.

25:29 – 28:27 | Building the transition the right way The financial, marketing and legal steps to take in order, plus the private equity money moving into concierge care.

28:27 – 28:42 | Closing thoughts and outro Todd thanks Ericka and Austin wraps the episode.