Скачать или смотреть Why Hospital–Insurer Deals Keep Breaking Down (Fee-for-Service vs Value-Based)

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Across the country, hospital systems and insurance companies are hitting the wall on contracts. We often hear “it’s about quality of care,” but when negotiations stall, it usually comes down to money. Here’s the simple breakdown 👇

The Two Money Buckets:

• 💵 Fee-for-Service (FFS): Paid per visit/procedure.

• 🎯 Value-Based Payments (VBP): Bonuses if hospitals/doctors hit quality & cost targets.

What’s happening right now:
• 🧮 If the math doesn’t work, contracts get cut—access changes for patients.

• 🏥 Many smaller providers struggle to qualify for VBP bonuses, which squeezes margins.

• 🔁 Hospitals often rely on VBP for profit—when targets or terms shift, deals get shaky.

What you can do (patient checklist):
🔎 Verify network status for your hospital and specialists.

🧾 Request an itemized bill and review your EOB (Explanation of Benefits).

🗂️ Document calls—date, rep name, reference #.

🧭 On Medicare Advantage? Ask about continuity-of-care if your provider goes out of network.

☎️ If you’re stuck, call 1-800-MEDICARE to review your options.

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“This is for educational purposes only and not to be taken as advice to act on. always consult with a licensed Medicare broker in your area.”