For over 18 years, we've helped healthcare professionals break free from insurance constraints to create thriving direct care practices. Our unique routine exam model ensures full Medicare/Medicaid compliance, qualifies for employer and tax-advantaged funding, and allows you to deliver exceptional world class exceptional care to patients who value your expertise.
Personal Story: I was billed out-of-pocket nearly $1,500 for three low-complexity primary care visits. No procedures. No advanced diagnostics. Just routine care. The charges were non-transparent, unpredictable, and completely disconnected from value. I did not simply pay them, I challenged them, but the experience confirmed what I already knew.
Fee-for-service medicine kills Americans.
Fee-for-service creates a system of hidden prices, surprise bills, administrative friction, and financial anxiety that causes people to delay care. When patients finally enter the system, they are sicker, their conditions are more advanced, and treatment is more expensive. The outcome is devastating: the United States has the most expensive healthcare system in the world and some of the worst public health outcomes of any developed nation. This is not a failure of clinicians. It is a failure of the payment model.
Healthcare has never been abstract to me. I grew up inside it. My father served as a U.S. Navy dentist and later built a private orthodontics practice in Southern California. My mother became a licensed pharmacist, worked in both independent and hospital settings, and eventually ran our family practice. Doctors, dentists, pharmacists, and their families filled my childhood. Healthcare was personal, human, and deeply familiar.
Over the next 16 years, I expected to follow the same path. Sports injuries redirected my college focus away from competitive athletics and toward pre-med and biology studies. As I reassessed my interests, my focus shifted to the liberal arts (English) major, music, and the creative arts. That path ultimately led me to law, where I became a corporate, real estate, and land-use attorney with significant trial and transactional experience focused on business planning, complex disputes, and commercial strategy, far removed, it seemed, from clinical medicine.
Healthcare pulled me back anyway.
Eighteen years ago, an internal medicine doctor asked me to help her create a concierge-branded practice model. After researching the market and attending a physician conference, I concluded that no one in the US seemed to understand exactly how and why cash subscription healthcare programs can be compliantly constructed to render patient fees qualified medical expenses, while simultaneously achieving Medicare compliance with no need to opt out of Medicare or stay outside plan networks. The programs we design allow healthcare professionals to bill plans not at all, some, or more. The model is built for the healthcare professional’s own flexibility, choice, and preference regarding plan revenue. That work pushed me directly into Medicare compliance, cash-based care, concierge medicine, and retainer practices. What I encountered was not clarity, but fear, misinformation, and poorly grounded assumptions. In fact, I found pervasive confusion regarding nearly all aspects of U.S. healthcare. I concluded that if no one understands the why of U.S. healthcare, there is little chance anyone truly comprehends the how.
Over the next eighteen years, I immersed myself in nearly every variation of U.S. cash healthcare, concierge medicine, direct primary care (DPC), executive and corporate health, functional and integrative medicine, longevity and lifestyle care, and low-fee public health education models. I watched some practices collapse financially while others generated extraordinary profits. I watched physicians burn out under one model and thrive under another. The question became unavoidable: why?
After years of research, regulatory analysis, historical study, and real-world observation, my team and I reached conclusions that remain largely absent from public discourse. The answers were not ideological. They were rooted in U.S. history, tax policy, Medicare statutes, federal guidance, economics, marketing theory, and human behavior. We identified a subscription care model tax-advantaged in the 1940s and rendered statutorily Medicare compliant with the creation of Medicare in 1965 (reinforced by federal statutes in 1996 and 2006). This model originated as a more personalized and higher-connection way to more effectively deliver life-extending healthcare that was then quietly privileged/protected as a model to enhance health for the powerful and wealthy. Today, any US healthcare model to compliantly provide any style or theory of healthcare with no need to opt out of Medicare, with plan integration flexibility, and with a full range of employer/tax advantaged funding options.
Today, my work is focused on empowering healthcare professionals to practice medicine the way they want to practice, using a proven care and compliance model that offers maximum regulatory protection, patient funding flexibility, pricing control, and insurance integration options. I work to combine a healthcare professional’s vision with proven compliance structures and business efficacy solutions.
Fee-for-service broke American healthcare.
I am committed to fixing it, one practice, one professional, and one patient relationship at a time.
Our solution: subscription and transparency. Patients pay one clear annual fee instead of surprise bills, and can use tax-advantaged funds to pay it. You earn predictable revenue without chasing claims.
Our solution: prevention over reaction. The subscription rewards keeping patients well, not billing for more visits. Patients check in early, and you catch problems before they grow.
Our solution: care without fear of cost. With the year already paid, patients seek guidance at the first sign of a problem instead of delaying care.
Our solution: executive health for all. The model corporations have used for decades to keep their leaders healthy is now available to any practice and its patients.
Direct primary care, concierge medicine, functional medicine, and longevity practices all promise freedom. Few deliver it while staying Medicare compliant and fully fundable. Our model rests on federal statutes, decades of Medicare and OIG guidance, and tax law. Here is how the common cash practice models compare:
| Style of Practice | Medicare Compliant | HSA/FSA/HRA/MSA Eligible and Employer Fundable | Bill healthcare insurance plans, if desired. | Preventive/Wellness Focus | Proven Profitability |
| Executive/Corporate Health | ✅ | ✅ | ✅ | ✅ | ✅ |
| Direct Primary Care (DPC) | ❌ | Partial/HSA only | ❌ |  |
❌ |
| Concierge Medicine Brand | |
|
✅ | |
✅ |
| Functional/Integrative Medicine | ❌ | ❌ | ❌ | ✅ | ❌ |
| Integrative Health | ✅ | ✅ | ✅ | ✅ | ✅ |
| Specialty Care | |
|
✅ | ✅ | |
| Lifestyle & Longevity (Routine Exam Model) | ✅ | ✅ | ✅ | ✅ | ✅ |
Executive health offers a premium experience. Our model delivers more: Medicare compliance with no need to opt out, full tax-advantaged and employer funding, and freedom to bill plans a little, a lot, or not at all. No other model offers this combination.
This means that virtually any healthcare specialty can offer routine exam services on a cash basis without Medicare compliance concerns, provided they are properly structured and not billed to plans as medically necessary services.
A service is "routine" when it is pre-sold as an available annual or follow-up exam, not in reaction to or because of any specific condition or medical necessity at the time of contracting.
None of the three federal statutes that exclude routine exams, check-ups, and physicals from Medicare coverage ever defined "routine" - this flexibility is both a strength and a source of confusion.
Healthcare professionals themselves determine if a service is "covered" by a plan (and therefore not part of "routine" exams) simply by following all plan requirements, coding properly, and submitting to the plan for reimbursement = covered.
If they don't do this = not covered.
This distinction is deceptively simple but confusing to healthcare professionals trained only in fee-for-service healthcare intended to retain our current health care system.
No payment may be made under [Medicare] for any expenses incurred for items or services… where such expenses are for routine physical checkups – 42 U.S.C. § 1395y(a)(7), Social Security Act
Jim Eischen is a nationally recognized expert with over 18 years of experience in private direct healthcare models and compliance. He has guided large provider networks, venture capital funds, national direct care enterprises, and healthcare professionals on implementing compliant direct care practice models.
Whether you practice direct primary care, concierge medicine, functional or integrative medicine, longevity, or specialty care, we will help you build a Medicare-compliant practice that patients value and you own.
