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KFF Health News published an article about some providers turning to a concierge medicine model, where patients pay a monthly or annual access fee; in exchange, providers limit their panel size (the number of patients that they see) so that their patients receive better service. The access fees "range from $1,000 to as high as $50,000 a year." One provider mentioned in the article charges patients at least $1,000 per year, and with the 800 patients that signed up, the extra $800,000 in revenue should go a long way towards alleviating the smaller patient base, perhaps even exceeding the loss of revenue from the other patients. The article also discussed the direct primary care model, which is similar to concierge medicine, but the providers do not accept insurance. One note is that by not dealing with insurance, the provider can avoid having to devote staff time to process insurance claims. Nevertheless, it is unclear whether such savings for the providers translate into savings for the patients.

KFF Health News published an article about some providers turning to a concierge medicine model, where patients pay a monthly or annual access fee; in exchange, providers limit their panel size (the number of patients that they see) so that their patients receive better service. The access fees "range from $1,000 to as high as $50,000 a year." One provider mentioned in the article charges patients at least $1,000 per year, and with the 800 patients that signed up, the extra $800,000 in revenue should go a long way towards alleviating the smaller patient base, perhaps even exceeding the loss of revenue from the other patients. The article also discussed the direct primary care model, which is similar to concierge medicine, but the providers do not accept insurance. One note is that by not dealing with insurance, the provider can avoid having to devote staff time to process insurance claims. Nevertheless, it is unclear whether such savings for the providers translate into savings for the patients.

In either of these models, the physician has less work and patients who can afford the access fee can enjoy a higher level of service. However, this model accentuates the shortage of primary care providers. Perhaps the emergence of this trend is not surprising given that newly trained doctors tend to gravitate towards more lucrative specialties, and that insurance companies have been using their leverage to squeeze out lower prices from providers, who in turn have been looking to higher volumes (shorter visits) to compensate.

Established in the 1990s, Medicare Advantage offered private insurers the opportunity to administer health plans for Medicare enrollees. The idea was that private insurers might be able to offer better service at a lower cost. For example, a private insurer might be more diligent in identifying and treating patients who are at greater risk of expensive treatments if the conditions of those patients were left unaddressed. Alternatively, private insurers might offer perks like gym memberships to encourage a healthier population. KFF Health News published an article about how an increasing number of providers are frustrated with the reimbursement from Medicare Advantage plans and are refusing their contracts.

Established in the 1990s, Medicare Advantage offered private insurers the opportunity to administer health plans for Medicare enrollees. The idea was that private insurers might be able to offer better service at a lower cost. For example, a private insurer might be more diligent in identifying and treating patients who are at greater risk of expensive treatments if the conditions of those patients were left unaddressed. Alternatively, private insurers might offer perks like gym memberships to encourage a healthier population. KFF Health News published an article about how an increasing number of providers are frustrated with the reimbursement from Medicare Advantage plans and are refusing their contracts.

Providers frequently complain about the reimbursement offered by traditional Medicare, but apparently, Medicare Advantage plans offer even less. One health system found that "traditional Medicare reimbursed Brookings Health System 91 cents for every dollar it spent on care in 2023, while Medicare Advantage plans paid 76 cents per dollar spent." That is, not only does the health system lose money when treating Medicare patients, they lose even more money treating Medicare Advantage patients. As some providers refuse to accept some Medicare Advantage patients, those patients might need to travel elsewhere for care, or transition back to traditional Medicare (which can be expensive for those who require supplemental insurance).

With health insurance premiums rising faster than inflation, policymakers look at different solutions to try to tame costs. KFF Health News reported on the current administration's executive order to mandate transparency healthcare pricing. This order is reminiscent of a similar directive issued in a previous term. While that directive was considered "pretty bold," the article lists a number of problems with the rollout, including enforcement and prices for procedures not actually performed by the indicated providers (e.g. a dentist's price for a knee replacement). The chief executive of a non-profit health policy research group called pricing transparency "a critical first step," not a silver bullet.

With health insurance premiums rising faster than inflation, policymakers look at different solutions to try to tame costs. KFF Health News reported on the current administration's executive order to mandate transparency healthcare pricing. This order is reminiscent of a similar directive issued in a previous term. While that directive was considered "pretty bold," the article lists a number of problems with the rollout, including enforcement and prices for procedures not actually performed by the indicated providers (e.g. a dentist's price for a knee replacement). The chief executive of a non-profit health policy research group called pricing transparency "a critical first step," not a silver bullet.

DocSpot aspires to include pricing transparency data in its provider profiles, although the timing of that feature is unclear. Hopefully, requirements set up by the current administration will make the data easier to interpret for the benefit of patients.

Many rural areas experience a shortage of medical providers, and KFF Health News reported that "more than one-fourth of the state's [Montana] residents live in an area with a shortage of primary care health professionals." The article lists some of the ways that the state legislature is considering to address that shortage. One pending bill, for example, would recognize licenses issued in other states for physician assistants and some others. Another bill would let physician assistants be considered "treating physicians" for the purposes of workers' compensation.

Many rural areas experience a shortage of medical providers, and KFF Health News reported that "more than one-fourth of the state's [Montana] residents live in an area with a shortage of primary care health professionals." The article lists some of the ways that the state legislature is considering to address that shortage. One pending bill, for example, would recognize licenses issued in other states for physician assistants and some others. Another bill would let physician assistants be considered "treating physicians" for the purposes of workers' compensation.

The shortage of medical professionals is a challenge that the nation will increasingly face, and it will be interesting to see how various institutions try to meet that challenge. Some solutions (such as recognizing licenses from other states) might work at the state or regional level, but more comprehensive solutions would likely be necessary at the national level.

KFF Health News reported on the state of New York's recent efforts to encourage the disclosure of medical costs to patients. Many practices require patients to agree in writing to pay for all charges not covered by insurance (requiring patients to sign "blank checks"), and a state law was recently passed to prohibit such practices (especially given that patients often are not presented with actual cost estimates when they are asked to sign those forms). Implementation of the law was delayed indefinitely. However, "Doctors and other providers would still be obligated to have the cost discussion with patients before the patient is asked to sign the form agreeing to pay for the service."

KFF Health News reported on the state of New York's recent efforts to encourage the disclosure of medical costs to patients. Many practices require patients to agree in writing to pay for all charges not covered by insurance (requiring patients to sign "blank checks"), and a state law was recently passed to prohibit such practices (especially given that patients often are not presented with actual cost estimates when they are asked to sign those forms). Implementation of the law was delayed indefinitely. However, "Doctors and other providers would still be obligated to have the cost discussion with patients before the patient is asked to sign the form agreeing to pay for the service."

Even though details still need to be worked out, it does seem that there is growing dissatisfaction with the status quo. Very few other industries (if any) have a standard practice of requiring their customers to agree to pay before the customers know the costs of the product or service. While it is true that complications can arise and that can make it difficult for providers to accurately estimate total costs, patients should not be expected to bear all of the challenges of that uncertainty.