Fee-for-Service Transition
Expert articles and analysis related to fee-for-service transition.
AI Summary â Last 30 Days
CMS and Congress are tightening the fiscal frame around both FFS and VBC: House Energy & Commerce scrutiny of the Medicare Physician Fee Schedule and MACRA underscores broad dissatisfaction with clinician payment updates, while CMSâs Medicaid state-directed payment proposal would extend OBBBA-authorized limits into managed care and certain FFS supplemental paymentsâpressuring hospitals, safety-net systems, and Medicaid ACO-like arrangements that depend on those dollars (HFMA on Medicaid SDPs).
For VBC stakeholders, the strategic issue is no longer a simple migration away from fee-for-service; it is how to operate in a hybrid reimbursement environment where FFS rate adequacy, supplemental Medicaid financing, care coordination codes, and downside-risk contracts all interact. Recent analysis questioning whether Medicare Advantage risk-based contracts materially reduce waste adds to the tension, suggesting payers and provider groups will face more scrutiny on whether risk transfer is producing measurable utilization, quality, and cost outcomesânot just shifting financial exposure (Penn LDI on MA risk contracts).
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