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https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:521373d4-84d5-447c-8a6d-8f344cae07d2
This article was written by Dr. Hemant Kalia with the support of Dr. Sahar Elezabi and Dr. Mark Adams. It will be published in the American Journal of Medicine and included in MSSNY Highlights. Click here for the full article.
Here are the highlights:
A misdiagnosis at the center of cost-control policy
Few facts about the US health system are as well established as its cost. Spending reached $5.26 trillion in 2024—$15,474 per person and 18.0% of the gross domestic product—after roughly tripling in nominal terms over two decades (1). What is less settled is the diagnosis. Much of the policy apparatus built since the mid-2000s rests on an implicit theory of the case: that costs rise because clinicians order too much care and are paid too generously for it. From that premise flow the dominant interventions of the era—prior authorization, medical-necessity review, narrow networks, downward pressure on physician fee schedules, and value-based contracts that place clinicians at financial risk for utilization.
If the premise were correct, two decades of intensifying clinical oversight should have bent the curve. They have not. The purpose of this editorial is to connect several independent bodies of evidence—national expenditure accounts, consumer price data, labor statistics, and international comparisons—and to show that the data point toward a different and largely structural explanation. The biggest drivers of American health care costs lie not in the examination room, but in the pricing systems and administrative machinery surrounding each clinical encounter.
Two decades of growth, before and after inflation
The appropriate first step to level the playing field is to remove economy-wide inflation confounders. Between 2004 and 2024 the Consumer Price Index for All Urban Consumers rose about 66% (2). Deflating national health expenditure to constant 2024 dollars—multiplying each year's spending by the ratio of the 2024 price index to that year's index—reduces, but does not eliminate, the growth. Real health spending still expanded by approximately 71% over the two decades. In other words, even after stripping out general inflation, the health sector grew markedly faster than the broad basket of goods and services against which it is measured.
This excess growth is the quantity that requires explanation. It cannot be attributed to general price inflation, because it survives adjustment for it. The natural next question is whether it reflects a commensurate expansion of clinical capacity—more physicians delivering more care to a growing and aging population?
It is not chiefly the doctors
It does not. The active physician workforce numbered 1,032,365 in 2024 (3), having grown by roughly 29% since 2004—approximately in line with population growth and well short of the ~71% real growth in spending (Table-1). The divergence is the central empirical observation of this editorial and is displayed in the Figure 1: when each series is indexed to its 2004 value, nominal spending, hospital expenditure, and estimated administrative spending all roughly triple, while the physician workforce barely rises above the line of general inflation. Whatever is driving real cost growth, it is not a proportional increase in the number of clinicians.
Where the money goes: prices and administration, not volume
Two converging lines of evidence locate the excess cost. The first is international. In the most cited cross-national comparison of recent years, Papanicolas et al. (2018) found that US utilization—hospital discharges, physician visits, and common procedures—was broadly similar to that of other high-income countries, yet the US spent roughly twice as much. The difference was driven by prices for labor, goods, and pharmaceuticals, and by administrative costs, which consumed about 8% of US spending under a narrow definition versus 1% to 3% elsewhere. The United States does not, on the whole, use conspicuously more care; it pays conspicuously more for each unit and spends far more administering the transaction. (4)
The second line is domestic and structural. Hospital care is, and has remained, the single largest category of national health spending—$1.63 trillion in 2024, about 31% of the total, ahead of physician and clinical services ($1.11 trillion) and retail prescription drugs ($467 billion) (1). Hospital expenditure has grown in close parallel with overall spending (Figure-1), and the literature attributes much of that growth to price rather than to volume, with provider consolidation a recurring mechanism: as regional hospital systems acquire competitors and physician practices, they gain leverage to negotiate higher commercial prices, frequently accompanied by facility fees on services that were previously billed at lower office rates.
An honest accounting of the administrative thesis
The administrative-cost literature is the empirical backbone of this argument, and it should be represented precisely. Himmelstein et al. (2020) estimated that administration costs had risen to 34.2% — about $2,497 per capita, against $551 in single-payer Canada—with the largest US-Canada gaps in insurer overhead, hospital administration, and physicians' insurance-related costs. A meaningful component of the increase since 1999 is attributable to the growing role of private managed-care plans in administering public programs, whose overhead substantially exceeds that of traditional Medicare. (5)
Why the orthodox remedies have underperformed
Seen in this light, several disappointments of the past two decades become coherent. Utilization management did not eliminate spending but relocated it: every prior-authorization requirement calls for a corresponding investment in coding, appeals, and revenue-cycle staff on the provider side, enlarging the very administrative layer that comparative data identified as excessive. Documentation mandates intended to improve quality consumed clinician time and generate demand for scribes and informatics personnel. Payment models that placed independent practices at financial risk accelerated their absorption into larger systems, a structural change that tends to raise, not lower, negotiated prices.
A reorientation of policy
If the diagnosis is structural, the remedies must be as well. Four priorities follow from the evidence assembled here, offered as directions rather than detailed prescriptions:
Conclusion
The United States has spent two decades managing its health care costs as though the problem lay with the people who deliver care. The data assembled here—national expenditure trends adjusted for inflation, a physician workforce that grew only with the population, international comparisons that find ordinary utilization at extraordinary prices, and an administrative apparatus that consumes roughly a third of every dollar—point elsewhere. Reasonable analysts still disagree about the precise weighting of prices, intensity, and administration, and that debate should continue. But the weight of the evidence is sufficient to warrant a change of aim. Until policy confronts prices, consolidation, and administrative complexity directly, the system will continue to spend more while asking clinicians to do more with less.
References
1. Centers for Medicare & Medicaid Services. (2025). National health expenditure accounts: Historical data and NHE fact sheet (2024). U.S. Department of Health and Human Services. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data date accessed: 5/05/26
2. Bureau of Labor Statistics. (2025). Consumer Price Index for All Urban Consumers (CPI-U): U.S. city average, all items [Data set]. U.S. Department of Labor. https://www.bls.gov/cpi/. date accessed: 5/05/26
3. Association of American Medical Colleges. (2025). 2025 key findings: U.S. physician workforce data dashboard. https://www.aamc.org/data-reports/data/2025-key-findings. date accessed: 5/05/26
4. Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. JAMA, 319(10), 1024–1039. https://doi.org/10.1001/jama.2018.1150
5. Himmelstein, D. U., Campbell, T., & Woolhandler, S. (2020). Health care administrative costs in the United States and Canada, 2017. Annals of Internal Medicine, 172(2), 134–142. https://doi.org/10.7326/M19-2818
Rochester, NY, August, 19,2026 - The Monroe County Medical Society has recognized Ghinwa Dumyati, MD and Barb Glassman with its 2026 Edward Mott Moore Physician and Layperson Awards. This award recognizes individuals whose dedication to the community goes above and beyond the usual call of duty.
2026 Edward Mott Moore Physician Award Ghinwa Dumyati, MD
Ghinwa Dumyati, MD, is an infectious diseases physician and Professor of Medicine at the University of Rochester Medical Center, where she directs the Communicable Diseases Surveillance and Prevention Program at the Center for Community Health & Prevention. She trained at the American University of Beirut before completing her residency and fellowship at the University of Rochester. She has practiced medicine in Rochester since 1995 and joined Strong Memorial Hospital in 2007. Since 2008, she has led infectious disease surveillance for the Rochester region of the CDC's Emerging Infections Program; data from this work help shape national public health policy. Locally, she led hospital collaboratives that reduced central line-associated bloodstream infections by 50% and C. difficile infections by 30%. The latter initiative received the Greater Rochester Quality Council's Performance Excellence Platinum Award. For more than a decade, she has also led a regional collaborative helping nursing homes establish antibiotic stewardship programs. During the COVID-19 pandemic, she helped facilities manage outbreaks and provided guidance on treatment and vaccines. This work was recognized with a University of Rochester Medical Center Alumni Service Award. Throughout her career, she has taught and mentored infectious disease fellows, residents, and public health students at the University of Rochester.
2026 Edward Mott Moore Layperson Award
Barb Glassman
After navigating the corporate world, Barb used her experience to start several small businesses in Rochester, NY. Her primary focuses include strategic direction, continuous improvement, business and professional growth. Barb has spent the last decade centered on humanizing the workplace. Her career began as the first female electrical engineering technology graduate at SUNY Alfred, and she later expanded into sales, marketing, and adult education. In parallel with her corporate career advancement, Barb worked behind the scenes at G-FORCE Collaborations, a marketing communications firm. In 2018, learning about Rochester's high poverty rankings, Barb shifted her focus to local economic and community development. This included a two-year coaching role at the Rochester Commissary kitchen incubator, where she also stepped in as interim president to ensure stability. As an ICF-certified executive coach with a "pay-it-forward" commitment, Barb mentors professionals through major transitions, with a special focus on guiding young people through early adulthood and career challenges. Today, she serves on multiple business and non-profit boards, co-founded DisruptHR ROC, and contributes to the Patient Clinician Alliance. Much of her current time is dedicated to equitable regional workforce development and helping the Greater Rochester region earn its ACT Work Ready certification.
About Monroe County Medical Society
Over 1,200 physicians are members of the Monroe County Medical Society/7th District Branch. The Monroe County Medical Society is a non-profit organization formed to extend medical knowledge and to advance medical science, to elevate the standards of medicine, to promote reforms and to enlighten and direct public opinion on the problems of health and medicine for the best interests of the people of Monroe County. For more information visit www.mcms.org or email mcms@mcms.org.
The Rochester Medical Orchestra will be presenting their summer concert: Classical Vintages, at Monroe Community Hospital on August 14, 2026 at 7PM. Here is a link: https://www.urmc.rochester.edu/events/event-detail/53479754542075
Here are the Physicians accepting new Patients at URMC for August.
Accepting Patients_August_by _County (002).pdf
Accepting New Patients_July.pdf
Article by:
Dr. Michael R. Privitera , Elon Slutsky, J. Richard Ciccone, Tiffany Chan, Xi (Sisi) Hu, Elizabeth L.B. Greene, Catherine Cerulli
https://acrobat.adobe.com/id/urn:aaid:sc:US:dc8a7c00-1e02-482e-a125-2b691ddaf7bd
By Rob Bell, Rochester Beacon
Michael Mendoza M.D. says the Rochester region’s health has not fully recovered from the COVID-19 pandemic.
Cardiovascular measures, maternal and child health, immunizations and blood pressure control are “still a challenge,” he said.
“The biggest challenge that hasn’t gotten better—and in some cases has gotten worse—is the disparity in blood pressure control between Black and brown populations and white populations. And that’s not OK.”
Mendoza, former Monroe County commissioner of public health and the face of the county’s response to the pandemic, is now senior medical director at Town Square Health, a Chicago-based company planning to open its debut health center in Rochester around September.
The site is expected to be near Westfall and Clinton in Brighton, close to a complex already used by many residents for medical care. It will focus on Medicare patients, including adults 65 and older and some younger patients who qualify for Medicare because of disability.
For Mendoza, the aim is not simply to open another primary care office. It is to test whether a different model of care can help prevent declines in health before patients reach a crisis point.
“I’m going to want to know that people are healthier,” Mendoza says. “Are they living longer and healthier lives?”
Town Square Health uses a value-based multispecialty care model for Medicare patients it calls Primary Care 3.0—a concierge-style experience.
Under the traditional fee-for-service model, doctors and health systems are generally paid based on the number of visits, services, and procedures they provide. A value-based model ties payment more closely to patient outcomes.
“Part of the reason we can spend more time with patients and be more thorough is because we get paid when the patients do well and not just when we see a lot of them,” says David Buchanan, CEO and co-founder of Town Square Health.
Buchanan, a Western Pennsylvania native, says Rochester appealed to him both because of the market and because the city felt familiar.
“When I first came to Rochester, it felt like coming home,” he says. “I feel like Pittsburgh and Rochester really have a lot of similar histories, and you can see it in even the infrastructure and the houses and the community.”
David Buchanan
Buchanan says Town Square Health may open more locations throughout Western New York. But “right now we’re laser focused on the Rochester area.”
He co-founded the company in 2025 after leadership roles at Oak Street Health and CVS Health.
CVS Health acquired Oak Street Health in 2023, adding a primary care network focused on value-based care for older adults and Medicare patients.
According to Buchanan’s LinkedIn profile, he served as Oak Street’s chief clinical officer, chief clinical and technology officer, and executive medical director before later working as chief innovation officer for health care delivery at CVS Health.
“David and I have known each other for a while,” says Mendoza, who grew up in Chicago and later moved to Rochester, where he has worked as a family physician, public health commissioner and health care executive.
The two doctors reconnected as Buchanan was looking to build local relationships.
“His commitment to prevention and community health is a perfect reflection of our Primary Care 3.0 vision,” Buchanan said after announcing Mendoza’s new role.
The doctors say Town Square Health’s model reflects what many clinicians want from their work: the ability to put quality first.
“There’s this element of being a physician that’s like a craftsperson,” Buchanan says. “You’re really trying to take the best care of individual patients.”
Still, value-based care is not without concerns.
While the model is designed to reward better outcomes rather than more visits, critics have raised questions about whether it can create new pressures on providers and patients.
Practices often need to invest heavily in technology, data systems, and reporting tools to track quality measures.
Town Square Health says it plans to use Heidi, an AI note-taking tool, during visits to reduce administrative work. Buchanan said the tool is meant to keep doctors from “staring at their laptops and typing” instead of looking at patients and listening. Patients who are uncomfortable with AI will be able to opt out.
The idea is that ambient documentation tools could transcribe clinical visits and generate draft notes; automated scheduling and patient reminders would reduce no-shows and minimize staff time on phone calls. Additional applications could include prior authorization tools to expedite insurance approvals and AI-supported triage and chat functions to address routine questions.
AI could also reduce physician burnout.
About 42 percent of U.S. physicians report burnout symptoms, according to a survey administered by the American Medical Association. The figure is down from 62.8 percent post-pandemic; however, even with that decline, physicians remain significantly more likely to experience burnout than workers in other fields, adding to concerns about whether the health care system can retain enough clinicians to meet rising demand.
There is also the question of how “value” is measured, and whether this model could create unintended consequences. For example, providers may have a financial incentive to limit referrals or order fewer tests to control costs and increase margins. That raises concerns about whether some patients could end up receiving less care than they need.
In an Instagram post, Town Square Health says its model, in addition to improving the health of aging adults, will “deliver returns for our investors.”
Asked who those investors are, a spokesperson replied in a written statement that Buchanan is “bootstrapping the company during our initial phase of operation. We are officially announcing our Seed Round of fundraising in Fall 2026. Our model creates a natural alignment between investor returns and patient outcomes by reducing operating costs and the total cost of care, and by improving patient engagement. This structure allows Town Square Health to generate sustainable financial performance beyond what has been previously achieved in legacy value-based care models.”
Company leaders say this model is designed to avoid some of these reported concerns.
Mendoza says he would evaluate the model by whether patients show improved health outcomes, such as better diabetes care, improved blood pressure control, and fewer unnecessary hospital visits. He says those outcomes are reported to payers as evidence that the model is helping keep patients healthy.
Sahar Elezabi, M.D., president of the Monroe County Medical Society, says Town Square Health’s model would be new to the Rochester market, although similar models exist in other regions.
MCMS is a physician-led organization that supports doctors through education, advocacy, networking and community collaboration.
Elezabi notes that most local primary care practices are affiliated with the University of Rochester, Rochester Regional Health, or federally qualified health centers such as Jordan Health and Trillium Health, and added that private adult primary care practices have continued to decline.
“This would be new, innovative in our area, and actually needed,” Elezabi says.
Michael Mendoza
Consolidation among major health systems and the decline of private practices have created a need for new options, Elezabi says, citing dwindling physician reimbursement, rising health care costs, and the challenges of operating a private practice as reasons for the decline.
“Private practices are small businesses, like any other small businesses,” she says. “So they’re really having a hard time competing, just surviving.”
While the region’s major health systems already use value-based contracts through accountable care organizations, Elezabi says the key issue is how effectively the model is applied.
“It’s not necessarily just about value-based contracting,” she says. “It’s how do you apply it and how do you run it? I think it’s a wise, smart move that would benefit the community. If the model is run correctly, with the needed resources and sticks with the laws and the regulations, I think it would be a really nice addition to our community.”
Town Square Health says it chose Rochester as its first market after looking for communities where it believed its Medicare-focused model could meet a need.
The company points to Monroe County’s Medicare Advantage enrollment, saying the county “has the highest Medicare Advantage enrollment rate of any major urban county in the United States.”
It also cited “fragmented care delivery, physician burnout, and an underinvestment in proactive senior-focused primary care” as factors that have left many Rochester Medicare patients without the “coordinated, relationship-driven care” the company wants to provide.
According to Common Ground Health, a local nonprofit health research and planning organization, one in five people in the Rochester-Finger Lakes region is 65 or older.
An AARP-commissioned data report found that the number of Rochester residents 65 and older living in poverty rose 70 percent from 2011 to 2021, from 3,633 to 6,175, or 22 percent of city residents in that age group.
This means that, for older adults, access to health care is determined by more than the availability of doctors. Transportation and mobility limitations, caregiver strain, high out-of-pocket costs, and the complexity of Medicare and Medicaid coverage can all affect whether people receive the care they need.
Mendoza says coordination is a frequent issue for older patients. “They say, ‘Well, it’s so hard to get from here to there and make all these appointments. Can we bring it all into one place?”
Town Square Health sees itself as filling a gap rather than competing with existing systems, as demand for primary care remains high.
“There’s not enough great primary care,” Buchanan says. “People are waiting three to six months for primary care. We want to do what we can to help address that.”
The initial Rochester team is expected to include providers, nurses, a practice manager and patient navigators.
Over the next five to 10 years, Buchanan says, the goal is to expand beyond the first Brighton-area center. He says success could mean serving about 20,000 patients across three or four centers in the Rochester area.
For Mendoza, the measure will be whether the model improves health outcomes in a region where older adults face growing needs and where post-pandemic inequities persist.
“There is a demand for a different way of doing care for a lot of people,” he says.
Rob Bell is a Rochester Beacon contributing writer and former Democrat and Chronicle reporter, photographer and editor. He also produces and hosts “Plants & Beats,” a podcast exploring mindfulness, music and culture.
Here is the list of URMC PCP's accepting new patients:
PC_1059_ACCEPTING_PATIENTS_June.pdf
Click here to see who is accepting new patients at URMC:
PC_1059_ACCEPTING_PATIENTS_ May.pdf
