A Savannah Magazine Ran Concierge and DPC as One Category. The HSA Rule That Took Effect in January Counts a Fixed Fee and Nothing Else.

Practice Spotlight by DPC Insider — Practice Desk
#concierge medicine#HSA#practice models#Georgia#membership pricing
Sources: A Different Kind of Health Club · Cornerstone Health — Concierge Care · Coastal Care Partners — Primary Care Options · Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018–23 · DPC Frontier — Tax Treatment · IRS Publication 969 — Health Savings Accounts and Other Tax-Favored Health Plans

Savannah Magazine published a feature on August 24 that opens with a sentence most people in this model would nod along to. “Concierge medicine and direct primary care are among the fastest-growing models in healthcare,” writes Ethan Mathews, under the headline “A Different Kind of Health Club.”

The reporting is solid. Two local physicians, real quotes, and an honest paragraph near the end admitting that these practices are not yet reachable for everyone. What the piece never does is separate the two models it names in its opening line.

Since January 1, that separation has a dollar figure attached to it.

What the two practices actually sell

Dr. Natalie Britt opened Cornerstone Health in Savannah in 2024, after a career in emergency and hospital medicine. “Many of the patients I cared for were not there because their conditions were unavoidable but because the system failed to create space for timely, comprehensive care upstream,” she told the magazine.

Cornerstone’s own website is careful in a way the article isn’t. Its Concierge Care page sets out what the practice calls “two ways to access care,” an insurance lane and a cash-pay lane, under a posted membership of $75 a month for ages 12 to 20 and $175 a month for adults 21 and older. In the insurance lane, the practice writes, “Your visit will be appropriately coded and submitted to your insurance company.” In the cash-pay lane there is a $60 visit fee collected at time of service for every appointment except lab draws. The practice also posts a separate direct primary care schedule, priced by age instead of by lane: $85 a month for children up to 21, $110 for adults 21 to 44, $135 for adults 45 and older, $175 for two adults in the same household who are both under 45, $200 when one of them is 45 or older, and $50 for each additional child. The page tells visitors they will see “the difference in the DPC and Concierge pricing structure.” Two structures, two price lists, and a site that keeps them apart.

Coastal Care Partners splits it further, into two named practices. Coastal Care Primary Care is the DPC side, and the company states it plainly: “No insurance accepted. Care is funded through membership fees.” Coastal Care Vitality is the concierge side, where “patients enroll in a concierge-style program, while eligible medical services are billed to insurance.” Medicare is accepted there.

Dr. Pam Gaudry, whom the magazine identifies as a direct primary care physician at Coastal Care, works the first of those. She opened her own DPC practice in Savannah in 2018 and brought her patients over in 2024. She caps her panel at 500. She spends an hour with each patient, and her team answers texts within five minutes.

“The key is taking excellent care of a small number of people,” Gaudry says.

Coastal Care names both models and puts them in separate practices. Cornerstone names both and prices them on separate pages. Neither site runs the two together the way the magazine does.

The line the tax code drew in January

Section 223 of the Internal Revenue Code now recognizes something called a direct primary care service arrangement, added by the One Big Beautiful Bill Act and applying to months beginning after December 31, 2025. The definition is tight. The arrangement has to provide “medical care consisting solely of primary care services provided by primary care practitioners,” and “the sole compensation for such care is a fixed periodic fee.” The fee is capped at $150 a month for an individual and $300 for a family, indexed for inflation.

Hold that phrase against Cornerstone’s concierge side, where the cash-pay lane adds a $60 charge to each visit and the insurance lane sends a coded claim to a carrier, and a fixed periodic fee is no longer the sole compensation in either lane. Whether that pushes the whole arrangement outside the definition is a question the statute leaves open. The direct primary care schedule on the same site sits on the other side of that line. Every individual tier on it, $85 through $135, falls under the $150 monthly ceiling. DPC Frontier reproduces the H.R. 1 language without reading it either way.

The exclusions tighten it again. Primary care services under the statute “shall not include” procedures requiring general anesthesia, prescription drugs other than vaccines, or laboratory services not typically administered in an ambulatory primary care setting. The sentence that follows that list hands the call to the agencies: the Secretary, after consulting HHS, “shall issue regulations or other guidance regarding the application of this clause.” What that does to a membership bundling in hormone therapy or IV infusion is unsettled. DPC Frontier reads the exclusions as an instruction about structure rather than a disqualifier, noting that “meds and labs should be ordered and passed through to the patient rather than bundled into the monthly fee and do not count toward the $150 cap.” Cornerstone already works that way on the concierge side, listing IV therapy, hormone therapy, medications and labwork as cash-pay rates on top of the membership.

None of this makes a hybrid practice improper, and none of it is a knock on Cornerstone, which labels its concierge offering concierge and says so on the page. The point is narrower. A patient with a high-deductible plan and a health savings account has a real financial question at the point of enrollment, and the phrase “membership medicine” does not answer it.

The data merges them too

The growth number quoted in the Savannah piece comes from Health Affairs, and it carries the same merge. Jane M. Zhu and colleagues at Johns Hopkins, Oregon Health & Science University and Harvard counted concierge and direct primary care in one category and found that practice sites grew 83.1 percent between 2018 and 2023, while participating clinicians grew 78.4 percent. It ran in the December 2025 issue.

That same study found roughly 60 percent of those clinicians still participated in Medicare, which the authors read as “suggesting concierge or hybrid practice.” The authors built that figure by matching clinician NPIs to Medicare’s Physicians and Other Practitioners Public Use Files, which are drawn from submitted claims, so it reflects billing rather than enrollment. It still does not establish how much care got billed, only that some did. What it does establish is that the figure most often cited as evidence of DPC’s growth counts a majority of clinicians who stayed enrolled with a payer.

The counterargument

The strongest case against caring about any of this is that almost nobody is affected. The tax treatment only matters to patients with money in a health savings account, and only people covered under a high deductible health plan can put money in one. A lifestyle magazine is not a benefits document, and the argument assumes most membership patients never raise tax treatment at all. Britt makes the more interesting version of the argument herself when she tells the magazine that “physician-entrepreneurs are developing more flexible payment models, making membership-based care accessible to a broader population.” Flexibility is the point of a hybrid. Forcing every practice into a fixed-fee box could shrink the number of doors a patient can walk through, which is a strange thing to advocate for in a country short on primary care.

That case holds right up until you look at who now owns the term. Until this year, “direct primary care” was defined by the people practicing it and by a patchwork of state statutes saying a membership isn’t insurance. As of January, it’s a federal term of art with a numeric test, and the test decides whether a patient’s money is spent pre-tax. Terms with money attached get borrowed. The looser the popular usage gets, the more often a patient will hand over $175 a month believing they bought the thing Congress described.

If you’re the physician setting that fee this year, the practical version is short. Decide which arrangement you’re running before you write the number down, put it on your pricing page in the same plain language Coastal Care uses, and don’t let a reporter’s shorthand become your patients’ assumption. You might find that the clearer label is the easier sale anyway.