Schroeder acknowledges that a transition away from fee-for-service will be complicated. "Phasing out implies that it will take some time," he says. "There may be pockets due to size or geographic isolation or difficulty in getting other forms of payment. You will still have some stand alone fee-for-service, but the commission's sense was we should try to make these more oddities than common practice."
Richard "Buz" Cooper, MD, a healthcare economist at the University of Pennsylvania's Wharton School, told HealthLeaders Media in an email exchange that eliminating fee-for-service has been a popular idea in the healthcare reform movement but that "it's hard to find evidence that FFS makes a difference."
"My impression from the various studies is that the added productivity of physicians under FFS counterbalances their poorer productivity under other systems of compensation, and the net result is that there is little difference," Cooper says.
The commission's 12 recommendations include increasing reimbursement for evaluation and management services for all physicians, while holding flat reimbursements for technical services provided by surgeons, radiologists and other specialists. Schroeder says fee-for-service does not reward physicians for preventive healthcare consultations and discourages them from spending time with chronic care patients to create a care regimen.
The skewed incentives of fee-for-service have created a widening pay gap between specialists and primary care physicians and have contributed to the nation's shortage of primary care physicians. The study notes that radiologists earned $315,000 on average in 2011 while primary care physicians earned $158,000.