October 20, 2026
Dear Patients,
We are writing to tell you about a change to how we sustain this practice: beginning January 1, 2027, we will be implementing an annual fee for all patients. This has not been an easy decision, and we are writing to help you understand our rationale - and why it is happening now.
We want to be direct about what this fee is, and what it is not. This fee is not a concierge fee and we are not changing our care model. It does not unlock any enhanced tier of care, faster appointments, or special access. Every patient will continue to receive the same high-quality medical care we have always provided. This fee exists for one reason: to help offset the widening gap between what it actually costs to practice medicine today and what insurers - including Medicare - pay us to do it. We think you deserve a candid explanation of why that gap exists, because it isn't unique to us. It's reshaping medicine across the country.
Medicare reimbursement has not kept pace with reality. According to the American Medical Association, Medicare physician payment - when adjusted for the actual cost of running a practice - has declined roughly 33% since 2001. To put it in plain terms, physicians today are paid meaningfully less, in real dollars, than they were paid to do the same work two decades ago, even as rent, staffing, technology, supplies, and regulatory compliance have all become more expensive. For 2026, the federal government did finalize an increase to the Medicare conversion factor (driven mostly by a one-year, temporary congressional adjustment), but that gain is offset for many services by a separate reduction they call an “efficiency adjustment.” The net effect, according to independent analyses from MedPAC and others, is that reimbursement continues to fall behind the actual cost of delivering care, even in years when the headline number looks like an increase.
Private insurance has not filled that gap, either. Each insurer negotiates independently, and the rates vary - but looking across our own contracts over the past decade-plus, a consistent pattern emerges: even our more generous commercial agreements have remained far below inflation over that period, and some of our contracts have barely moved at all in a decade. Not a single one of our private payer contracts has kept pace with the rising cost of running a practice over that stretch. Regardless of how these negotiations play out insurer by insurer, the result for an independent practice is the same. Revenue per visit is effectively shrinking in real terms, year after year, while the cost of delivering that visit keeps climbing.
We are also, increasingly, a rarity. Independent, physician-owned practices like ours are disappearing. According to the AMA’s Physician Practice Benchmark Survey, the share of physicians in wholly physician-owned private practice fell from 60.1% in 2012 to 42.2% in 2024, which was the first time it dropped below half. Using a narrower definition of true independence, the Physician Advocacy Institute found the share fell even further, from 37.8% in 2019 to just 22.4% in 2024. Over the same period, the share of physicians employed by hospitals, health systems, and private-equity-owned groups has dramatically increased.
That trend matters beyond economics. When a practice is acquired by a hospital system, an insurance company, or a private equity firm, medical decisions tend to shift away from the physicians actually treating patients. These organizations’ incentives are not always aligned with what’s best for the individual patient. We believe there is real value, for you, in being cared for by a practice where the people making decisions about your care are the same people who answer to you directly, not to a distant corporate parent.
Remaining independent has always meant operating with thinner margins and less financial support than a hospital-owned or private-equity-backed system has behind it. We have absorbed those pressures for as long as we reasonably could without asking anything additional of our patients. This fee is how we intend to keep doing that - to remain independent, physician-led, and accountable to you, rather than to a system that has other priorities.
We have not made this decision lightly, and we understand it may raise questions. We’re glad to discuss it with you directly.
Sincerely,
The Neurology Center
Frequently Asked Questions
What is this fee for?
It helps us cover the growing gap between what it costs to run an independent medical practice and what insurers - including Medicare - actually pay us for the care we provide. It is not a charge for any additional service; it supports the practice as a whole.
Does paying this fee get me faster appointments, extra time with my doctor, or any other special treatment?
No. This is not a concierge-medicine arrangement. Every patient will continue to receive the same quality of care, the same access to appointments, and the same attention from their physician.
Why is this happening now?
The pressure has been building for years. Medicare reimbursement, adjusted for inflation, has declined roughly 33% since 2001, according to the American Medical Association. Our private insurance contracts have not kept pace with inflation either - some have increased only slightly over periods as long as a decade. Meanwhile, the cost of staffing, technology, rent, supplies, and regulatory compliance keeps rising. We held off on asking anything of our patients for as long as we reasonably could.
Is this a copay, and will my insurance reimburse me for it?
No, it is not a copay or a covered medical service, so it is not something we can bill to insurance. It's a practice administrative fee, separate from any charges tied to a specific visit or procedure.
Why doesn't insurance just pay doctors more?
Medicare's payment formula is required by law to be budget-neutral, which means that any increases in one area must be offset by cuts elsewhere - so payment updates rarely keep pace with the actual cost of running a practice. Private insurers negotiate independently with each practice and those negotiated increases have also consistently lagged behind inflation.
Why does it matter that your practice is independent?
Independent, physician-owned practices like ours are becoming rare: according to the AMA, the share of physicians in wholly physician-owned practices fell from about 60% in 2012 to about 42% in 2024. When a practice is bought by a hospital system, insurance company, or private equity firm, decisions about your care start to reflect that owner's priorities rather than your physician's judgment. Staying independent means your doctors are the only people deciding how best to care for you.
Are other practices doing this too?
Yes. Annual or membership-style fees, in various forms, have become increasingly common among independent practices facing the same reimbursement pressures we describe here.
Who can I talk to if I have more questions?
We're glad to discuss this with you directly - please reach out to the administrative staff or your neurologist with any questions or concerns.