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May 3, 2023
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David Burda
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Economics Outcomes System Dynamics
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Is Fee-For-Service Medicine More Like a Rash, an Addiction or an Old Car?

I love analogies. I think they’re one of the most effective ways to describe something or someone when a verbatim description just won’t do or would be too complicated to put into words. When I worked for a content marketing agency in Minneapolis, I wrote about the use of analogies to explain complex ideas in a blog post called “The Art of Analogy.”

I thought about that post this week when I was trying to come up with an analogy to describe fee-for-service medicine (FFS). It’s a legacy payment mechanism that just won’t go away no matter how hard the industry says it’s trying to move toward value-based reimbursement systems (VBR) over FFS.

That slog was clear in a new survey of 1,000 primary care physicians (PCPs) conducted by The Commonwealth Fund. According to the survey:

  • 71% of PCPs said they get paid by one or both types of FFS reimbursement contracts: one with no monetary links to performance; the other with links to performance-based bonuses.
  • 46% of PCPs said they get paid by one or both types of VBR contracts: shared-savings models with upside and/or downside risk; the other capitation or population-based payment models.

FFS wins 71% to 46%.

That’s too bad because, according to the survey, PCPs that got paid under one or both types of VBR contracts were more likely to participate in accountable care organizations, to participate in patient-centered medical homes, and to screen patients for social determinants of health.

The Commonwealth Fund said FFS is “dominating” primary care for two reasons: “First, changing how care is paid for can require significant upfront investments that not all practices, especially underfunded primary care practices, can manage. Second, for practices to participate in VBP (value-based payment), they must be well-prepared to take on financial risk and potential losses, which is a daunting prospect for small or independent primary care practices.”

When I sat down to write this post about the survey, I wanted to use an analogy to describe FFS. That’s where a hit a roadblock. Is FFS like a rash that won’t go away? Yes, but that assumes you want the rash to go away, and you’re doing everything you can to make the rash go away. Is FFS like an addiction? Yes, but that assumes the addiction is bad for you, and, in this case, the addiction is keeping PCPs alive. Is FFS like an old car? Maybe. It’s dependable. It gets you where you need to go. You can fix it yourself. It’s not as risky as a new car, which is more expensive, and you can’t fix yourself. OK, I’m going with the old car.

What analogy would you use to describe the industry’s lingering attachment to FFS? If you have a better one, send me an email and let me know. Thanks.

And thanks for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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