We've compiled answers to the most common questions healthcare professionals ask about implementing Medicare-compliant direct care practices. If you don't see your question answered here, please contact us for personalized guidance.
The Social Security Act specifically excludes “routine physical checkups” from Medicare coverage (42 U.S.C. § 1395y(a)(7)). This statutory exclusion, reinforced in 1996 and 2006, creates the legal foundation for direct care services focused on routine exams without requiring Medicare opt-out.
When a healthcare practice offers pre-sold routine exam services rather than services triggered by medical necessity, these services are not covered by Medicare and can legitimately be provided for direct payment.
If during a routine exam you identify a medical issue requiring intervention, you have three options:
The choice is entirely yours as the healthcare professional. Coverage is not determined by the patient’s condition it is solely determined by what the healthcare professional does or doesn’t document and bill to insurance.
Based on Office of Inspector General guidance, these are the key practices to avoid:
Our routine exam model is specifically designed to avoid these compliance pitfalls.
These are three distinct tax-advantaged funding options:
HSA (Health Savings Account)
Approximately $170 billion in total U.S. HSA assets in 2025
FSA (Flexible Spending Account)
HRA (Health Reimbursement Arrangement)
When properly structured, routine exam services can qualify for all three funding options.
Yes. Employer funding of routine exams can be structured through various legal mechanisms:
These mechanisms create a pathway for employer funding, potentially making your cash healthcare model accessible to a much broader patient population.
While cash healthcare models can’t solve all equity challenges, our approach addresses accessibility in several ways:
While these solutions don’t completely solve healthcare’s equity challenges, they represent meaningful progress toward a more accessible system.
As an independent practice owner, you have complete freedom to implement whatever financial assistance or sliding scale policies align with your values. Many healthcare professionals using our model:
The financial stability of the routine exam model often provides the flexibility to serve patients across the economic spectrum.
Yes. The routine exam model allows you to remain in-network with insurance plans and bill for covered services as you choose. Unlike many direct care models that require abandoning insurance entirely, our approach provides complete flexibility. You can:
This flexibility is a key advantage over models that require abandoning insurance entirely.
Yes. The routine exam model allows you to integrate health coaching services into a wide range of medical practices, including concierge, executive health, preventive, integrative, and functional medicine models. This approach supports longitudinal care, behavior change, and improved patient outcomes beyond traditional visit-based care.
The optimal patient panel size varies by specialty and service model, but typically falls within these ranges:
Practice Type | Typical Patient Panel Size |
|---|---|
Primary Care | 300-600 patients |
Functional Medicine | 150-300 patients |
Specialty Care | 100-250 patients |
Mental Health | 75-150 patients |
These panel sizes allow for comprehensive care while maintaining financial sustainability. Most practitioners report significant reductions in total patient panel size but increases in overall revenue and satisfaction.
Pricing varies significantly based on specialty, service scope, geographic location, and practice goals. Typical annual fees fall within these ranges:
Practice Type | Annual Fee Range |
|---|---|
Primary Care | $1,800-$3,600 |
Functional Medicine | $3,600-$8,400 |
Specialty Care | $3,000-$6,000 |
Mental Health | $3,600-$7,200 |
Many practices offer tiered service options at different price points to increase accessibility while still maintaining financial viability. Our practice formation process includes customized financial modeling to determine optimal pricing for your specific situation.
The optimal legal structure depends on your specific circumstances, goals, and state regulations. Common options include:
Our practice formation process includes legal structure recommendations tailored to your specific situation, including considerations for:
Most practices complete implementation within 8-10 weeks. The exact timeline depends on your current practice structure, specialty, and desired implementation pace. Our implementation process includes:
We can adjust this timeline based on your specific needs and circumstances, whether you prefer a rapid transformation or a more gradual transition.
Both approaches can work, but we typically recommend a phased implementation for established practices:
Phase 1: Develop the complete model and infrastructure Phase 2: Identify ideal candidates within your existing patient panel Phase 3: Begin offering the model to existing patients Phase 4: Gradually expand as patients convert and capacity allows Phase 5: Adjust traditional practice elements as routine exam practice grows
This approach minimizes disruption while allowing you to refine your model based on early feedback. For new practices, a complete implementation from the start is often preferable.
Patient response varies based on communication approach, value proposition, and patient demographics. Typically:
The key to positive patient response is clear, transparent communication focused on the enhanced value and experience they’ll receive, not just the change in payment model.
The routine exam model can be implemented with various technology solutions depending on your preferences and existing systems. Essential technology components include:
Many practices can leverage their existing technology infrastructure with modifications rather than requiring completely new systems.
Clear communication is essential for successful implementation. We provide templates and guidance for patient communications that emphasize:
Most successful transitions focus on communicating the enhanced value and experience rather than just the change in payment model.
While similar in some ways, our routine exam model differs from other direct care models:
These distinctions create significant advantages in regulatory compliance, patient accessibility, and practice flexibility.
Our routine exam model shares some similarities with DPC but offers several important advantages:
These advantages make our approach more flexible and accessible than traditional DPC models.
Our routine exam model uses the same fundamental approach as executive health programs but is adaptable to any healthcare specialty and patient population. We leverage the same statutory exclusions that have protected executive health programs for decades while making this approach accessible to a broader range of healthcare professionals and patients.
The key similarity is the focus on pre-scheduled routine exams rather than reactive, necessity-based care, but our approach can be implemented at various price points and service levels.
Our consulting approach differs from others in several key aspects:
These distinctions create significant advantages in practice ownership, sustainability, and compliance confidence.
No. Unlike corporate platforms that take 25-40% of your revenue indefinitely, we offer a simple flat-fee approach. Our $10,000 practice formation package provides everything you need for a one-time fee with no ongoing financial obligations.
For those who desire continued support, we offer an optional year-long implementation support service for 8% of gross cash fees above $150,000, but this is entirely optional and limited to a single year.
Yes, we provide marketing guidance as part of our practice formation package, including:
For those desiring more intensive marketing support, we offer an additional Marketing & HIPAA Implementation service ($5,000 full-day consultation) that provides more comprehensive marketing development.
The routine exam model works best for healthcare professionals who:
Our complimentary consultation helps determine if this approach aligns with your specific goals and practice vision. During this conversation, we explore your current challenges, desired outcomes, and optimal implementation approach.
Yes. We work with healthcare professionals throughout the United States. Our services are provided remotely via video conference and phone, with all necessary documentation handled electronically.
For clients desiring in-person consultation, we offer on-site services with travel expenses covered by the client.
The process begins with a complimentary consultation to discuss your practice goals and determine if our services are a good fit. During this 30-minute session, we’ll:
To schedule your consultation, simply click here or call 619-919-5395.
Contact Information:
Jim Eischen
Eischen DPSC LLC
2323 Locust Street
San Diego, CA 92106
619-919-5395
jim@eischenlawoffice.com
