<P> Private - practice physicians and small group practices are particularly vulnerable to declining reimbursement for patient services by government and third - party payers . Rising regulatory demands, such as the purchase and implementation of costly electronic health record systems, and increasing vigilance by government agencies tasked with identifying and recouping Medicare fraud and abuse, have bloated overhead and cut into revenue . </P> <P> While most practices have succumbed to the need to see more patients and increase FFS procedures to maintain revenue, more physicians are looking to alternate practice models as a better solution . In addition to value - based reimbursement models, such as pay - for - performance programs and accountable care organizations, there is a resurgence of interest in concierge and direct - pay practice models . When patients have greater access to their physicians and physicians have more time to spend with patients, utilization of services such as imaging and testing declines . </P> <P> FFS is a barrier to coordinated care, or integrated care, exemplified by the Mayo Clinic, because it rewards individual clinicians for performing separate treatments . FFS also does not pay providers to pay attention to the most costly patients, which could benefit from interventions such as phone calls that can make some hospital stays and 911 calls unnecessary . In the US, FFS is the main payment method . Executives regret the changes to managed care, believing that FFS turned "industrious, productivity - oriented physicians into complacent, salaried employees ." General practitioners have less autonomy after switching from a FFS model to integrated care . Patients, when moved off of a FFS model, may have their choices of physicians restricted, as was done in the Netherlands' attempt to move to co-ordinated care . </P> <P> When physicians cannot bill for a service, it serves as a disincentive to perform that service if other billable options exist . Electronic referral, when a specialist evaluates medical data (such as laboratory tests or photos) to diagnose a patient instead of seeing the patient in person, would often improve health care quality and lower costs . However, "in the private fee - for - service context, the loss of specialist income is a powerful barrier to e-referral, a barrier that might be overcome if health plans compensated specialists for the time spent handling e-referrals ." </P>

Who is the individual paid on a fee for service basis