Beyond Fee-For-Service: The Shift to Per-Patient Reimbursement

For decades, the financial engine of American healthcare has run on a simple, yet increasingly flawed, equation: do more, bill more. In the fee-for-service (FFS) model, we are incentivized to focus on volume—managing widgets rather than managing health. As a physician executive and oncologist, I have spent my career operating at the intersection of clinical medicine and healthcare finance. The conclusion I have reached, through years of policy advocacy and financial modeling, is clear: to save the viability of our practices and improve patient outcomes, we must move beyond the "hamster wheel" of FFS and embrace per-patient reimbursement.

The Misalignment of Incentives

In my role as Chief of Radiation Oncology at Luminis Health, I evaluate strategic initiatives and capital purchases with an eye toward long-term sustainability. In the traditional FFS model, technological advancements that improve patient quality of life—specifically those that shorten treatment times (hypofractionation)—often penalize the provider financially.

If we treat a patient in five fractions instead of forty because the clinical evidence supports it, FFS reimbursement models often slash the revenue for that episode of care. This creates a perverse incentive where efficiency is punished. We need a system that decouples payment from the number of times a patient walks through the door, focusing instead on the value delivered during their entire episode of care.

The Case for "Per Patient," Not "Per Fraction"

I have spoken extensively to academic chairs and industry leaders about the necessity of shifting our mindset from reimbursement "per fraction" to reimbursement "per patient".

Episodic payment models, or case rates, align the payer, the provider, and the patient.

• For the Provider: It offers predictable revenue streams and rewards clinical efficiency.

• For the Payer: It stabilizes costs and reduces administrative burden.

• For the Patient: It ensures that treatment decisions are based solely on the best clinical evidence, not on maintaining departmental revenue.

Leading the Charge: The ROCR Model

This transition is not hypothetical; it is the current focus of my work on the Board of Directors for the American Society for Radiation Oncology (ASTRO). As Chair of the Health Policy Council, I am actively advocating for the Radiation Oncology Case Rate (ROCR) Value-Based Care Program.

The ROCR model represents a legislative initiative to reverse the trend of declining Medicare reimbursement by establishing a simplified, episodic payment structure. It is designed to protect radiation oncology services in rural and underserved areas while incentivizing high-quality, evidence-based care. This is the kind of "bridging of medicine, management, and mission" that is required to drive financially sustainable models of care.

The Way Forward

My background in investment banking taught me that financial analysis and market strategy are crucial for health system management. However, the spreadsheet must never obscure the patient.

The transition to value-based care is inevitable. As we look toward 2026 and beyond, we face major changes in reimbursement. We can either wait for these changes to be forced upon us, or we can lead the conversation. By championing per-patient reimbursement, we secure a future where physicians are paid for their expertise and outcomes, not just their activity.

It is time to ensure that the payment model supports the cure, not just the treatment.