West Hills · Lake Oswego · Close-In Portland Concept Model

Unhurried preventive cardiology built around 300 members—not 2,400 charts.

Traditional hospital cardiology panels exceed 2,400 patients, compressing complex cardiovascular risk management into rushed 15-minute visits weeks after symptoms arise. Willamette Preventive & Concierge Cardiology models a pure prevention-and-access specialty practice capped at 300 members: 60–90 minute executive consultations, same-day or next-day appointments, direct physician messaging, and multi-decade atherosclerotic risk engineering.

Explore Prevention Protocol Compare Membership Models

300 Capped Member Panel vs. 2,400–3,000+ in hospital cardiology

60–90 min Executive Heart Physical Annual deep-dive + 45 min follow-ups

Same / Next Day Direct Cardiologist Access Human answer ≤ 3 rings · 24/7 direct reach

6.2+ hrs/yr Dedicated Physician Time vs. ~42 min/patient/yr traditional

Time & Access Architecture

Why panel size determines clinical depth

Prevention fails when a specialist has 42 minutes per year to review lipids, imaging, blood pressure trends, and family history. Adjust the simulated concierge panel below to see how capping enrollment transforms physician availability per member.

Simulated Concierge Panel Cap 300 members

Target Portland solo-cardiologist band: 250–300 active members.

Unhurried Concierge Density (8.8× time multiplier)

Optimal concierge density: 60–90 min executive evaluations, same-day acute slots open daily, unhurried direct physician text response.

8.9× Annual Physician Attention Direct cardiologist hours vs. metro norm

4 / day Scheduled Clinic Pace vs. 22–28 patients/day in fee-for-service

Clinical Service Menu

Deep prevention, precision diagnostics, and unconflicted coordination

By deliberately stepping off the invasive catheterization and stent treadmill, a preventive concierge cardiologist aligns 100% with keeping members out of the procedure suite—referring acute interventions to trusted Portland hospital partners only when clinically warranted.

01 · Atherogenic Lipidology

Advanced Particle & Lipoprotein Profiling

Standard cholesterol panels miss discordant atherogenic particle burden and inherited risk.

Annual ApoB, inherited Lp(a), and NMR lipoprofile particle sizing
High-sensitivity vascular inflammation (hs-CRP) & insulin resistance tracking
CLIA-waived point-of-care lipid and HbA1c checks for rapid titration

02 · Coronary Imaging

CAC Scoring & CCTA Plaque Stratification

Move from population risk calculators to direct visualization of your coronary arteries.

Low-radiation Coronary Artery Calcium (CAC) referral (~$100–$200 partner cash rate) & side-by-side review
High-resolution Coronary CT Angiography (CCTA) coordination for non-calcified soft plaque
Serial plaque stabilization targets rather than waiting for obstructive stenosis

03 · Structural & Functional Echo

Resting & Stress Echocardiography + 4D TEE

Coordinated transthoracic and exercise stress imaging paired with interactive structural anatomy education.

Accredited Portland partner echocardiography & cardiopulmonary stress testing
Valvular, chamber, and diastolic function tracking reviewed frame-by-frame
Interactive 3D/4D transesophageal structural heart walkthroughs

Companion Clinical Tool: Launch Interactive 4D TEE Workstation ↗

04 · Continuous Telemetry

Ambulatory Rhythm & Hemodynamic Streams

Capture intermittent arrhythmias and nocturnal blood pressure surges invisible to office cuffs.

In-suite 12-lead resting ECGs and multi-day patch Holter / event monitors
Cellular home blood-pressure cuffs (Omron / Withings) synced to your chart
Apple HealthKit resting heart-rate, HRV, and AFib wearable burden review

05 · Cardiometabolic & Genetics

VO2max, Familial Risk & Longevity Prescription

Cardiorespiratory fitness and metabolic resilience are among the strongest predictors of survival.

Familial hypercholesterolemia, cardiomyopathy & polygenic risk review where indicated
Structured Zone-2 & peak VO2max exercise prescription, sleep & nutrition plan
Evidence-led lipid-lowering (statin, ezetimibe, PCSK9i, bempedoic acid) & GLP-1 coordination

06 · White-Glove Advocacy

Annual “State of Your Heart” Dossier

Proactive year-round quarterbacking across primary care, subspecialists, and hospitals.

Comprehensive annual written “State of Your Heart” roadmap letter
Birthday lab nudges, pre-travel cardiac clearance & post-hospital check-in calls
Direct cardiologist-to-interventionalist advocacy if hospital care is ever required

Transparent Retainer Architecture

Two clean membership architectures modeled for Portland

Positioned squarely within national concierge cardiology benchmarks ($225–$600/mo), this concept contrasts a CMS-compliant Hybrid retainer against an all-inclusive Medicare Opt-Out Direct-Pay membership—with a standard 12% household discount for spouses or partners.

Billing Cadence

Annual Prepay Monthly Retainer

Include Spouse / Partner (−12% 2nd membership)

Option A · Widest Payer Compatibility

Hybrid Access + Insurance

Retainer funds non-covered executive prevention, 24/7 access, and care coordination; covered medical visits & diagnostics bill insurance/Medicare.

$333 / mo effective (billed $4,000/yr)

Standard monthly option: $350/mo ($4,200/yr) · Individual enrollment

Saves $200/yr vs. monthly billing

60–90 min annual executive preventive review & written “State of Your Heart” dossier
Same/next-day scheduling & direct Spruce/phone physician access
Subsidized annual ApoB, Lp(a) & NMR lipoprofile coordination
Covered sick/follow-up visits, EKGs & Holters billed to commercial insurance or Medicare
Structured strictly for non-covered ancillary services per CMS/OIG rules

Option B · Zero Insurance Friction

Direct-Pay Comprehensive

Physician formally opted out of Medicare (2-year CMS private contract). One transparent retainer bundles consultations and in-suite diagnostics.

$400 / mo effective (billed $4,800/yr)

Standard monthly option: $425/mo ($5,100/yr) · Individual enrollment

Saves $300/yr vs. monthly billing

Everything in Hybrid plus all office & telehealth cardiology visits bundled
In-suite 12-lead resting ECGs, ambulatory BP/wearable telemetry & point-of-care labs included
Annual ApoB, Lp(a) & NMR advanced lipid panel included in retainer
Transparent cash partner rates (~$100–$200 CAC) for external imaging
Cleanest regulatory posture for 65+ Medicare-eligible members under 2-year private contract

2025–2026 National Concierge Cardiology Pricing Benchmarks
Practice / Benchmark	Published Fee	Model Structure	Market Context
Carolina Concierge Cardiology (NC)	$225 / mo ($2,700 / yr)	Capped concierge cardiology	Quarterly / annual billing floor for pure specialty access
SilverHeart Concierge Cardiology	$4,000 / yr ($3,500 spouse)	Tiered cardiology retainer	Up to $7,000/yr when bundled with expanded care-team tier
DoctorsCGA (Fort Lauderdale, FL)	$400 / mo ($4,800 / yr)	Cardiology-only or PCP bundle	$6,000/yr (<65) or $7,200/yr (65+) bundled w/ PCP & geriatrics
MDVIP-Style Networks (Reference)	$1,800–$2,200 / yr	Primary care only (not cardiology)	Illustrates mass-market PCP floor below specialty cardiology
Portland Metro Target Range	$300–$450 / mo	Hybrid ($350) or Direct-Pay ($425)	Affluent 45–70 cohort; zero existing pure concierge cardiology clinics

Founder & Founding Cardiologist Operating Blueprint · Portland, OR

Unit economics, 36-month cashflow valley, and Oregon SB 951 CPOM architecture.

A 300-member preventive cardiology clinic combines SaaS-like recurring revenue (~65–75% clinic unit gross margin, <8% annual churn target) with zero catheterization capex. Launching in Oregon requires solving two hard constraints up front: recruiting the founding non-interventional cardiologist and structuring a genuinely physician-controlled PC + back-office MSO under ORS § 58.375.

Run Panel & P&L Simulator Review ORS § 58.375 Matrix 18-Month Roadmap & Risks

Interactive Financial Model

Panel unit-economics & 36-month cashflow ramp simulator

Model steady-state profitability alongside the Month 1–24 working-capital valley (assuming a 55-member pre-launch founding cohort, <8% annual churn, and adding a 2nd Medical Assistant above 300 members).

Scenarios:

Billing & Regulatory Variant

Hybrid + Insurance Direct-Pay Opt-Out

Active Member Panel 300 members

Target solo cap: 250–350 (50 to 500 range)

Monthly Membership Retainer $375 / mo

Portland benchmark: $300–$450/mo ($225 to $600)

Founding Cardiologist Base + Guarantee $480k / yr

Portland non-interventional all-in: $450k–$550k/yr

Clinic Staffing, Lease & Fixed Opex $28,000 / mo

MA, Coordinator, 0.5 PM, 1,500 sf NNN, EHR/Hint, malpractice

Startup Working-Capital Reserve $320k

Operating runway buffer ($200k–$400k; +~$205k legal/TI build-out)

Break-Even Panel 189 members 63% of 300-member target

Annual Gross Revenue $1,522,800 $1.35M retainers + $173k visits

Annual Net Operating Income +$482,688 +$40.2k/mo · 31.7% operating margin

Clinic Gross Margin 66.1% $143/member/mo delivery cost (pre-MD)

Months to Break-Even Month 8 From 55 founding-cohort launch

Runway Minimum Cash +$158,420 Trough at Month 7 · Reserve solvent

36-Month Panel Ramp & Cumulative Cash Reserve

All-in enterprise capital incl. ~$205k legal/TI/equipment build-out: $525,000

Without working capital to bridge Months 1–10, a concierge practice stalls in the ramp. Pre-selling a 50–55 member founding cohort is the highest-leverage de-risking move prior to signing a lease.

36-Month Ramp Trajectory Milestones
Timeline	Active Panel	Monthly Revenue	Monthly Opex	Cumulative Cash

Gating Legal Constraint · ORS § 58.375 & § 58.376

Oregon SB 951 / HB 3410 corporate practice of medicine blueprint

In June and July 2025, Oregon enacted SB 951 and HB 3410 (effective January 1, 2026 for new entities; active litigation in Eugene Emergency Physicians v. PeaceHealth), creating the strictest CPOM statute in the United States. The classic “captive friendly-PC” playbook used in Texas or Florida is explicitly barred here: governance must be genuinely physician-controlled.

Physician-Owned PC (ORS Ch. 58)

100% Clinical & Operating Autonomy

100% owned & governed by Oregon-licensed cardiologist(s)
Hires, supervises, sets compensation for, and terminates all clinicians (cardiologists, MAs, nurses)
Exclusive control over clinical protocols, diagnostic equipment selection, coding & fee schedules
Owns medical records (HIPAA Covered Entity), payer contracts / Medicare 2-yr private contracts & segregated PC bank accounts
Retains right to terminate MSA without MSO seizing the medical practice

ORS § 58.375 Firewall

Written FMV MSA & Statutory Bans

Permitted Fee: Fixed or cost-plus Fair Market Value (FMV) fee backed by independent valuation
Banned: Percentage-of-revenue sweeps transferring clinical profits to MSO
Banned: Dual employment where MSO employs/pays the “friendly” PC physician
Banned: Stock-transfer lockups letting MSO replace the physician-owner
Banned: Unlawful clinician non-compete, NDA & non-disparagement traps

Founder Back-Office MSO (LLC)

Pure Non-Clinical Infrastructure

Non-physician founder owned Oregon LLC / Corp
Medical office lease (1,200–2,000 sq ft @ ~$25–$35/sf NNN) & calm tenant build-out ($50–$150k)
Non-clinical SaaS stack (Elation Health, Hint Health billing, Spruce comms, website/CRM)
Brand, community heart seminars, wealth-manager & concierge-PCP referral outreach
Bookkeeping, non-clinical HR, RCM vendor oversight & HIPAA Business Associate ops

Interactive Pre-Formation & Licensing Gate Checklist

Check off structural gates as verified with specialist Oregon healthcare counsel prior to capital deployment.

3 / 9 gates verified (33%) · Entity & Recruiting Formation

Execution Sequencing & Risk Playbook

18-month launch roadmap, lean stack, and ranked risks

Synthesized directly from the Portland operations plan and risk analysis: resist hiring or buying imaging hardware ahead of panel growth, validate cardiologist + waitlist demand before signing a lease, and budget ongoing compliance.

Months 0–2

Legal Architecture & Site Thesis

Retain Oregon healthcare attorney ($25–$50k budget) for ORS § 58.375 entity memo; compare Portland vs. Vancouver, WA CPOM trade-offs; lock Hybrid vs. Medicare Opt-Out election.

Months 2–6

Cardiologist Recruiting & Waitlist

Recruit ABIM non-interventional cardiologist via 12–24 mo income guarantee or PC equity co-ownership; launch founding-member waitlist targeting 50 paid deposits.

Months 4–8

Suite Build-Out & Lean Stack

Lease 1,500 sq ft Westside / Lake Oswego suite; light TI ($50–$150k); configure Elation + Hint Health + Spruce; file CLIA waiver (~$180); bind malpractice ($15–$30k/yr) & HIPAA SRA.

Months 6–9

Credentialing & Referral Channels

Complete 90–120 day payer credentialing or CMS 2-yr opt-out affidavit; brief Portland concierge PCPs (AIM Health NW, GreenField Health) & wealth-advisor/family-office partners.

Months 9–18

Soft Launch to 300-Member Cap

Onboard first 50–100 founding members (2-yr rate lock); enforce <8%/yr churn & ≤3-ring phone SLA; add 2nd MA at ~260 members; defer in-house echo ($150–$400k) until 400+ members.

Lean Launch Staffing & Purpose-Built Technology Stack (1,500 sq ft Suite)
Function / Role	Launch Allocation	Portland Benchmark	Operational Role & Stack
Cardiologist (PC-Employed / Owner)	1.0 FTE	$450k–$550k / yr	ABIM Cardiovascular Disease; non-interventional prevention & relationship anchor
Medical Assistant (PC)	1.0 FTE (+1 @ 310)	$50k–$65k / yr	Rooming, vitals, resting 12-lead ECGs, CLIA-waived draws & prior auths
Concierge Member Coordinator	1.0 FTE	$55k–$70k / yr	≤3-ring answer SLA, onboarding, partner CAC/echo scheduling, retention (<8% churn)
Practice Manager (MSO)	0.5–1.0 FTE	$36k–$48k / yr (0.5)	Vendor ops, Hint Health reconciliation, wealth-advisor & employer channel ops
Core Software & Telemetry	SaaS + BAA	$12k–$24k / yr	Elation Health (or Athenahealth) EHR · Hint Health retainers · Spruce Health secure text · Apple HealthKit / cellular BP

Ranked Start-Up Risks & Pre-Capital Mitigations

RISK #1 · HIGHEST

Recruiting the Founding Cardiologist

Leaving a $500k+ health-system role for a startup requires rare alignment. Mitigation: 12–24 month funded income guarantee, genuine PC co-ownership, zero hospital call/weekends, and starting outreach on Day 1 (6–12 mo lead time).

RISK #2 · STRUCTURAL

Oregon CPOM Restrictions (SB 951 / HB 3410)

Strictest anti-captive-PC regime nationally limits MSO control and profit sweeps. Mitigation: FMV fixed/cost-plus MSA drafted by Oregon healthcare counsel, or counsel-led comparison with a Vancouver, WA initial clinic 15 minutes north.

RISK #3 · MARKET DEPTH

“Niche Within a Niche” Addressable Market

Narrower buyer pool than concierge primary care (affluent 45–70 w/ cardiac risk or family history). Mitigation: Portland currently has zero direct competitors; partner with concierge PCPs and family offices where buyers cluster.

RISK #4 · CASHFLOW VALLEY

Unit-Economics Sensitivity During Ramp

Stalling at 120 members burns ~$30–$50k/mo against fixed physician comp. Mitigation: Pre-sell 50 paid founding-cohort deposits prior to signing a lease and maintain 6+ months working capital ($420k–$540k total opex reserve).

RISK #5 & #6 · MEDICARE & KEY-PERSON

CMS Billing Rules & Solo-Physician Concentration

Balance-billing violations in Medicare or solo-MD illness/departure can halt operations. Mitigation: Lock Medicare Opt-Out vs. ancillary-only fee review pre-launch; cultivate part-time associate pipeline for 400+ member expansion.

RISK #7 & #8 · OPTICS & DRIFT

Two-Tier Scrutiny & Evolving Litigation

Concierge specialty care invites ethical scrutiny while CPOM case law evolves. Mitigation: Explicit charity-care / sliding-scale allocation, free community heart-screening seminars, and recurring annual legal compliance budget.