Why Is It so Hard to Kill Fee-for-Service Medicine?

Consultants, pundits, and wonks are touting how we should all prepare for the new world of value-based care and reimbursement. In the meantime, there is a lot of money to be made in complexity.

It is hard to kill fee-for-service medicine. Most cite it as one of the root causes of the ills that plague Sick Care USA and they want change now. The Obama administration is treading lightly taking an incremental approach.

Why is it so hard to kill FFS payment?

1. Too many people make too much money doing it that way.

2. Politicians are afraid of enacting too much change too soon.

3. Entire industries, like EMR, CPT coding, and others have been built around optimizing the fee for service model.

4. Some would claim it would be like other "socialist" countries with more government power.

5. Many are wary of how the payment negotiations would play out and the end result.

6. Some want to get rid of third-party payment altogether and this is just making a bad system worse.

7. Many think "value" is a smoke screen and a ploy to pay providers less.

8. Pay for performance is not working.

9. Some stress that patients should decide what they want and how much they should pay for it and not be forced into a "panel" of patients.

10. There’s a presidential election campaign going on.

Consultants, pundits, and wonks are touting how we should all prepare for the new world of value-based care and reimbursement. In the meantime, we continue to wait for the new cost-curve-bending messiah while dysfunctional EMRs continue to churn out notes that optimize fee-for-service payment, ICD-10 gurus are ramping up their webinars and seminars, and doctors and their billers just keep on keeping on. There is a lot of money to be made in complexity. Just ask the IRS and the ecosystem that feeds from those teats.