The conversion offer: the yes-rate that has to clear before you send it

What share of a panel converts?

There is no current benchmark. The one government measurement of this question is more than twenty years old: in an October 2004 survey of 112 self-identified concierge physicians, the Government Accountability Office found practices carrying an average of 326 fee-paying concierge patients against an average of 2,716 patients the same physicians reported for the year before they converted 1Ref 1U.S. Government Accountability Office (GAO) (2005).Physician Services: Concierge Care Characteristics and Considerations for Medicare.The framed 2004 benchmark used as history rather than forecast: an average of 326 concierge patients against an average of 2,716 patients the year before converting (roughly one in eight), GAO's own caution that the 112 self-selected respondents cannot be projected to other physicians, the finding that Medicare and non-Medicare patients joined in roughly similar proportions, and the survey's transition-support figures (67 percent remaining available to treat non-joining patients; 3 percent versus 46 percent on individual letters)..

That is roughly one in eight. GAO states plainly what the ratio cannot do: the 112 respondents were not randomly selected, and the results cannot be projected to other physicians 1Ref 1U.S. Government Accountability Office (GAO) (2005).Physician Services: Concierge Care Characteristics and Considerations for Medicare.The framed 2004 benchmark used as history rather than forecast: an average of 326 concierge patients against an average of 2,716 patients the year before converting (roughly one in eight), GAO's own caution that the 112 self-selected respondents cannot be projected to other physicians, the finding that Medicare and non-Medicare patients joined in roughly similar proportions, and the survey's transition-support figures (67 percent remaining available to treat non-joining patients; 3 percent versus 46 percent on individual letters).. The survey also predates the direct primary care market in its current form, and every subscription habit your patients have picked up since.

But a benchmark was never the number that decides this.

The share of your panel that says yes is an outcome. The share that has to say yes for the practice to carry itself is an input, and it is computable this week, out of your own remittance data, before a single letter goes out.

The yes-rate your arithmetic requires

Two numbers produce it, and both sit in your own records. Take the collections the panel produced over the last twelve months, from the remits rather than from charges. Divide that by the annual membership fee. The quotient is the number of members that replaces the revenue, and that member count divided by panel size is the yes-rate the offer has to clear.

Put arbitrary figures through it once, to see the shape: a panel of 1,800 patients producing $220,000 a year.

Those inputs are invented. The arithmetic is not, and it moves faster than intuition does. Halving the fee does not halve your margin for error. It doubles the number of people who have to say yes. Measured against GAO's one in eight, the $150 row leaves room to fall nearly half short and still hold. The $75 row is already behind before anyone declines 1Ref 1U.S. Government Accountability Office (GAO) (2005).Physician Services: Concierge Care Characteristics and Considerations for Medicare.The framed 2004 benchmark used as history rather than forecast: an average of 326 concierge patients against an average of 2,716 patients the year before converting (roughly one in eight), GAO's own caution that the 112 self-selected respondents cannot be projected to other physicians, the finding that Medicare and non-Medicare patients joined in roughly similar proportions, and the survey's transition-support figures (67 percent remaining available to treat non-joining patients; 3 percent versus 46 percent on individual letters)..

Collections are only the starting point, because the cost side moves too. If the conversion ends payer billing, the staffing and clearinghouse cost of that work leaves the target, while card processing now takes a percentage of every fee. Set the target as what you need to earn plus what the new model costs to run, then divide again.

If the required share lands above what you believe this panel will do, a conversion is not the only route to that income; locum and 1099 rates are a separate calculation with their own floor.

The fee level that keeps an HSA patient eligible

A membership priced at $150 a month or less for one person, or $300 where the arrangement covers more than one person, can be structured as a direct primary care service arrangement that federal tax law does not treat as disqualifying coverage for a health savings account, for months beginning after December 31, 2025 2Ref 2Office of the Law Revision Counsel, U.S. House of Representatives (2025).26 U.S.C. § 223 — Health savings accounts (subsection (c)(1)(E), Treatment of direct primary care service arrangements).The $150 per month per individual and $300 per arrangement covering more than one person fee level below which a direct primary care service arrangement is not treated as disqualifying HSA/HDHP coverage, its enactment in Pub. L. 119-21 section 71308, and its effective date for months beginning after December 31, 2025.. Above those figures the arrangement stops fitting the definition.

Congress set the amounts in Pub. L. 119-21, section 71308, enacted July 4, 2025 2Ref 2Office of the Law Revision Counsel, U.S. House of Representatives (2025).26 U.S.C. § 223 — Health savings accounts (subsection (c)(1)(E), Treatment of direct primary care service arrangements).The $150 per month per individual and $300 per arrangement covering more than one person fee level below which a direct primary care service arrangement is not treated as disqualifying HSA/HDHP coverage, its enactment in Pub. L. 119-21 section 71308, and its effective date for months beginning after December 31, 2025.. They cap nothing you may charge. They mark the line above which a patient who holds a high-deductible plan and funds a health savings account acquires a tax reason to decline.

The definition is written around primary care services, so a specialty membership may not fit it at all. Whether yours does is a question for your CPA with the statute in front of them, and it is worth asking before the price is printed.

The Medicare slice has a gate before it has a yes-rate

Part of your panel cannot be asked the same question yet. Charging an existing Medicare beneficiary a membership fee for services Medicare already covers, beyond what Medicare's charge limits allow, generally requires a written private contract with that beneficiary acknowledging that no Medicare claim will be filed for your services and that the beneficiary is responsible for the full charge 3Ref 3Office of the Law Revision Counsel, U.S. House of Representatives (1997).42 U.S.C. § 1395a — Free choice by patient guaranteed (subsection (b), Private contracts).The legal gate on charging an existing Medicare-beneficiary patient a membership fee beyond Medicare's charge limits: the written per-beneficiary private contract stating no Medicare claim will be filed, and the 2-year opt-out affidavit that renews automatically absent notice at least 30 days before the period ends..

The contract sits on top of an affidavit, and the affidavit is the part that binds. Opting out commits you by affidavit to a two-year period in which no Medicare claim may be filed for any beneficiary, and it renews automatically for another two years unless you file notice at least 30 days before the current period ends 3Ref 3Office of the Law Revision Counsel, U.S. House of Representatives (1997).42 U.S.C. § 1395a — Free choice by patient guaranteed (subsection (b), Private contracts).The legal gate on charging an existing Medicare-beneficiary patient a membership fee beyond Medicare's charge limits: the written per-beneficiary private contract stating no Medicare claim will be filed, and the 2-year opt-out affidavit that renews automatically absent notice at least 30 days before the period ends.. Opting out mid-career is therefore a calendar entry as much as a decision, and the date worth writing down is the one 30 days ahead of the close.

That gate is a legal one. Behavior is a separate matter, and on that the same GAO survey reported Medicare and non-Medicare patients who had been under a physician's care before the conversion joining the new practice in roughly similar proportions on average 1Ref 1U.S. Government Accountability Office (GAO) (2005).Physician Services: Concierge Care Characteristics and Considerations for Medicare.The framed 2004 benchmark used as history rather than forecast: an average of 326 concierge patients against an average of 2,716 patients the year before converting (roughly one in eight), GAO's own caution that the 112 self-selected respondents cannot be projected to other physicians, the finding that Medicare and non-Medicare patients joined in roughly similar proportions, and the survey's transition-support figures (67 percent remaining available to treat non-joining patients; 3 percent versus 46 percent on individual letters).. One dated, self-selected sample forecasts nothing, but it does suggest the insurance mix of a panel is not by itself what decides who says yes.

What the offer itself has to contain

A monthly membership billed to a card until someone cancels is a negative option offer, and the Federal Trade Commission's enforcement policy statement sets three requirements for one: clear and conspicuous disclosure of the material terms before billing information is taken, express informed consent obtained separately from the rest of the transaction, and a cancellation mechanism at least as simple to use as the sign-up 4Ref 4Federal Trade Commission (2021).Enforcement Policy Statement Regarding Negative Option Marketing.The three federal negative-option requirements a recurring monthly membership offer must meet: clear and conspicuous disclosure of material terms before billing information is taken, express informed consent obtained separately from the rest of the transaction, and cancellation at least as simple as sign-up..

State law can sit above that floor, and one state's version is worth reading even if you practice elsewhere. California makes it unlawful to fail to present automatic renewal terms clearly and conspicuously before the agreement is fulfilled, or to charge a consumer without first obtaining affirmative consent, and since an amendment effective January 1, 2025 a consumer who signed up online must be able to cancel exclusively online, at will 5Ref 5California State Legislature (2025).California Business and Professions Code Section 17602 (Automatic Purchase Renewals).One state example of a consumer-law floor above the federal standard: California's automatic-renewal disclosure and affirmative-consent requirements, and the amendment effective January 1, 2025 requiring that a consumer who signs up online be able to cancel exclusively online.. That is California's rule and nobody else's. Your own state's consumer statute governs your enrollment page, and it is worth finding before the page is built.

None of it raises the yes-rate. What it changes is which yeses survive, so the count that matters is the one you take at month twelve.

What the patients who say no are owed

Notice far enough ahead for the patient to secure another physician, and help with the transfer of care. That is the American Medical Association's ethics guidance for ending a patient-physician relationship, and a conversion that moves non-joiners off the panel is that ending, whatever the letter calls it 6Ref 6American Medical Association, Code of Medical Ethics (2016).Opinion 1.1.5, Terminating a Patient-Physician Relationship.The standing ethical duty owed to a patient who does not convert and is moved off the panel: notice far enough in advance for the patient to secure another physician, and facilitation of the transfer of care.. The obligation runs to the patient and does not pause for a change in business model.

GAO asked its respondents what they did for the patients who did not join. Sixty-seven percent reported staying available to treat essentially all of them until each had found a new physician. Writing an individual letter on a departing patient's behalf was the least used step in the list: 3 percent did it for all such patients, and 46 percent did it for none 1Ref 1U.S. Government Accountability Office (GAO) (2005).Physician Services: Concierge Care Characteristics and Considerations for Medicare.The framed 2004 benchmark used as history rather than forecast: an average of 326 concierge patients against an average of 2,716 patients the year before converting (roughly one in eight), GAO's own caution that the 112 self-selected respondents cannot be projected to other physicians, the finding that Medicare and non-Medicare patients joined in roughly similar proportions, and the survey's transition-support figures (67 percent remaining available to treat non-joining patients; 3 percent versus 46 percent on individual letters)..

The broad step was common in that table and the individual step was rare. Both are work, both land in the same quarter as the conversion, and both are done for people who have stopped paying you. The hours belong in the budget before the letters go out.

Write the required rate down before the offer goes out

Compute the required rate first, date it, and keep it somewhere the first three months of results can be set against it. The offer moves in one direction only: a patient who receives a conversion letter has been told the practice is changing, and nothing is left to adjust afterwards except a price you have already published.

• The required member count and the required share, computed from twelve months of remits and the panel size on the day you count it.
• The price, and whether it sits under the $150 or $300 figure that keeps a direct primary care arrangement clear of a patient's health savings account eligibility 2Ref 2Office of the Law Revision Counsel, U.S. House of Representatives (2025).26 U.S.C. § 223 — Health savings accounts (subsection (c)(1)(E), Treatment of direct primary care service arrangements).The $150 per month per individual and $300 per arrangement covering more than one person fee level below which a direct primary care service arrangement is not treated as disqualifying HSA/HDHP coverage, its enactment in Pub. L. 119-21 section 71308, and its effective date for months beginning after December 31, 2025..
• Your Medicare position: whether the affidavit is filed, when the current two-year period ends, and the date 30 days before that 3Ref 3Office of the Law Revision Counsel, U.S. House of Representatives (1997).42 U.S.C. § 1395a — Free choice by patient guaranteed (subsection (b), Private contracts).The legal gate on charging an existing Medicare-beneficiary patient a membership fee beyond Medicare's charge limits: the written per-beneficiary private contract stating no Medicare claim will be filed, and the 2-year opt-out affidavit that renews automatically absent notice at least 30 days before the period ends..
• The enrollment page's disclosure, consent and cancellation steps, checked against the federal standard and your own state's 4Ref 4Federal Trade Commission (2021).Enforcement Policy Statement Regarding Negative Option Marketing.The three federal negative-option requirements a recurring monthly membership offer must meet: clear and conspicuous disclosure of material terms before billing information is taken, express informed consent obtained separately from the rest of the transaction, and cancellation at least as simple as sign-up..
• The transition plan for non-joiners, with the notice period and who handles record transfers, written before the first letter 6Ref 6American Medical Association, Code of Medical Ethics (2016).Opinion 1.1.5, Terminating a Patient-Physician Relationship.The standing ethical duty owed to a patient who does not convert and is moved off the panel: notice far enough in advance for the patient to secure another physician, and facilitation of the transfer of care..
• The member count at month twelve, because a cancellation in month four spends the same as a no in month one.

Set the first review at ninety days after the first billed month, with the required share and the observed share side by side. If the observed share is short, the decisions still available are the price, the term and the size of the panel you keep serving, and all three are cheaper to change at ninety days than at twelve months.