EP299: FFS (Fee for Service) Is a Whole Business Model—It's Not Just a Way to Get Paid, With Alan Kaplan, MD, MBA, Assistant Professor of Urology at Georgetown University and a Practicing Urologist

In Episode 299, Stacey Richter talks with Alan Kaplan, MD, MBA, assistant professor of urology at Georgetown University and a practicing urologist, about why fee-for-service is a whole business model — not just a way to get paid — and what that means for specialists trying to evolve.

WHAT YOU'LL LEARN

✅ Why fee-for-service shapes how practices structure their entire business, not just how they bill

✅ Why FFS businesses have an inherent incentive to add labor rather than adopt labor-saving technology

✅ Why technology in health care has historically expanded the top line rather than making the bottom line more efficient

✅ What specialists need to be thinking about to stay relevant over the next five years

✅ Why the relationship between PCPs and the specialists they refer to matters more than ever

WHY THIS MATTERS

Dr. Alan Kaplan argues that fee-for-service isn't just a payment mechanism — it's a business model that shapes staffing, technology adoption, and strategy. Because FFS businesses only get paid when a human performs a billable service, they have little incentive to adopt technology that reduces billable hours, which is why health care technology has tended to expand revenue rather than cut costs. As capitated primary care and value-based models spread, specialists face a real strategic choice about how to evolve, and Dr. Kaplan makes the case that the relationships between PCPs and the specialists they refer to will be central to that transition.

MENTIONED IN THIS EPISODE

🔗 EP292, with Brian Klepper, PhD

🔗 EP219, with Arshad Rahim, MD, MBA, FACP

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:51 Who are we actually discussing when we use the term specialist?

05:58 How does the PCP taking on more risk affect the specialists' path to value-based care (VBC)?

09:42 "Technology leads to … a reduction in labor burden … but in health care, that really hasn't been the case."

11:36 "Technology … in health care … has never really been about making the bottom line more efficient. It's been about expanding the top line."

13:39 What do specialists need to be considering if they want to stay relevant in the next 5 years?

14:27 EP292 with Brian Klepper, PhD.

16:53 Is there a future where specialists can transition from FFS to VBC while skipping the messy middle of a transition?

18:37 "The way we always did things is not the way that we have to always do things in the future."

25:20 "When all is said and done, the relationship between [PCPs] and the specialists that they refer … those relationships are really, really important."

26:14 EP219 with Arshad Rahim, MD, MBA, FACP.

28:13 What's going to be a big driver for providers to become more independent in the next 5 to 10 years?