How to start a direct primary care practice

To start a direct primary care practice, define what the membership includes, how patients reach you, and how you will cover their care when you are away. Then review state membership rules, Medicare status, your employment agreement, and the usual business setup. Build the budget around the work the fee must support. A clear service agreement and a realistic capacity plan matter more than copying another clinic's membership price.

Direct primary care (DPC) generally replaces insurance billing for included primary care with a periodic fee, as the AAFP describes. Legal and tax sources below were checked October 12, 2026; review your own arrangement with qualified advisers.

How do you start a direct primary care practice?

Write the membership outline before choosing software or a price. Include visits, messages, procedures, tests, exclusions, and coverage during absences. Then check whether the model works within your state's rules and your Medicare plans. That sequence lets you test the cost and capacity of the service you are promising.

1. Review your employment agreement, including outside work and patient communications.
2. Confirm scope, ownership, and any collaboration requirements for your profession and state.
3. Draft the membership service list and access policy.
4. Have counsel review state DPC and insurance rules, cancellation terms, and the agreement.
5. Decide how you will handle Medicare beneficiaries before accepting them under private contracts.
6. Complete the entity, identifiers, malpractice, records, and privacy setup in the private-practice guide.
7. Test the membership economics and patient experience before recruiting the first members.

What should a DPC membership include?

A membership should answer what a patient can receive, when, and at what additional cost. Be specific about access. “Message the practice” leaves unanswered who reads the message, when to expect a reply, and what to do with an urgent concern. State those terms in language a patient can repeat back.

Agreement item	Decision to make
Visits	Which appointment types are included and how scheduling works
Messages	Channels, response hours, and the route for urgent concerns
Tests and procedures	What is included, what costs extra, and who bills outside services
Coverage	Who handles care when the clinician is away
Outside care	What the membership does not pay for, including hospital and specialist services
Payment and cancellation	Billing dates, renewal, refunds, and how either party ends the agreement

A DPC membership is not a substitute for planning how to pay for care outside the agreement. Explain that boundary early, before a patient compares your membership fee with an insurance premium.

How is DPC different from concierge medicine?

The useful distinction is what the membership pays for and whether the practice also bills insurance. In the AAFP's comparison, DPC fees cover a broad set of primary care services without routine payer billing, while concierge practices may retain insurance billing. The agreement matters more than the label on the website.

Question	DPC planning focus	Concierge planning focus
What does the fee buy?	Included primary care	Defined membership services or amenities alongside any separately billed care
What work supports payment?	Membership billing and service delivery	Membership billing plus any payer billing
What should a patient understand?	Which care remains outside the membership	Which charges go to membership, insurance, or the patient separately

For the insurance-plus-membership path, read the concierge practice guide. For a broader model comparison, use the primary care practice guide.

How do you set a membership price and panel limit?

Work backward from the service and workload. Estimate appointments, preparation, messages, results, documentation, and coverage. Then compare that capacity with the recurring expenses and income the practice must support. Keep the estimate visible so you can revise it when real use differs from your assumptions.

Use these planning equations with your own inputs:

• Monthly contribution per member = membership revenue retained after refunds and payment costs, minus costs that increase with each member.
• Members needed to cover planned monthly spending = monthly fixed spending divided by contribution per member.
• Clinical capacity = available clinician time divided by expected total work per member, including work between visits.

These are budgeting tools, not revenue forecasts. Separate clinician compensation, taxes, debt payments, and a reserve in your own model. Stress-test slower enrollment, higher service use, and time away. If the number of members needed to pay the bills exceeds the number you can serve, change the service design, expenses, or pricing assumptions before launch.

The startup-cost guide helps organize the underlying quotes. Avoid setting a panel limit solely from someone else's survey average.

What does Medicare opt-out require?

A membership agreement does not opt a clinician out of Medicare. CMS explains that eligible clinicians using the opt-out path must submit an affidavit and enter private contracts with Medicare patients. The election is not made patient by patient, and emergency or urgent care has special rules.

Ask the relevant Medicare Administrative Contractor and counsel to confirm eligibility, the effective date, private-contract wording, filing requirements, and renewal. Do this before furnishing care under that arrangement. The concierge guide's Medicare section links directly to the regulations and explains the timing differences.

Can patients use an HSA for DPC in 2026?

Certain DPC arrangements can coexist with eligibility to contribute to a health savings account (HSA), starting January 1, 2026. The member must otherwise qualify. IRS Notice 2026-5 explains the test, including the fixed periodic fee, eligible primary care, and a 2026 monthly aggregate limit of $150 for one person or $300 for an arrangement covering more than one person.

The arrangement's terms matter, even if a member declines a particular service. The definition excludes general-anesthesia procedures, prescription drugs other than vaccines, and lab services not typically provided in ambulatory primary care. HSA reimbursement has no corresponding fee cap: an otherwise qualifying arrangement above those limits can be paid from an HSA, but disqualifies the member from contributing while enrolled. Have a tax adviser review both questions before describing your membership as HSA-compatible.

Use the IRS guidance when drafting the included-service list. Do not assume a “DPC” label or a particular price alone satisfies the tax rules.

What should you test before opening?

Ask a colleague to act as a prospective member. Have them explain what is included, how to reach the practice, what happens after hours, and how to cancel. Then test an outside referral, an unexpected lab result, and coverage during a clinician's vacation. Revise the agreement and workflow wherever their answers differ from yours.

Where can Vye Health help?

Vye Health helps providers launch, run, and grow private practices. Vye manages licensing, credentialing, malpractice insurance, and your website, and payer contracts if you want them.

Bring the draft membership agreement and your capacity assumptions to discuss the support your model needs. Apply to Vye Health.