Why Are Pediatricians Fighting Outcomes-Based Payment?

As healthcare shifts towards outcomes-based and risk-based payment models, pediatricians are voicing concerns. Many in the field are resisting the idea of being paid based on actual results rather than the volume of services delivered. Instead, pediatricians continue chasing RVUs (relative value units), HEDIS (Healthcare Effectiveness Data and Information Set) metrics, and the endless minutiae of insurance coding.

But as we cling to fee-for-service incentives, we’re overlooking increasingly troubling trends in pediatric care. Outcomes are stagnating or worsening. Large pediatric practices are selling to private investors more interested in profits than quality. And the system we have is perpetuating more of the same: more patient volume, more tweaks to maximize billing, and more pressure on providers to do more with less—while the real needs of children and families remain unmet.

Why are we resisting a model that could actually shift our focus to real, meaningful improvements in children’s health? Are we so entrenched in the current system that we can’t see its flaws? Or is it time to confront some uncomfortable truths about our approach?

Are We More Focused on Revenue Than Results?

For too long, pediatric care has been structured around volume. Pediatricians often measure success by RVUs—billing codes that assign value to each service provided—and by HEDIS metrics, used as a checklist for quality. But do these metrics actually reflect better care, or are they simply fueling a system that rewards volume over value?

The fee-for-service model has made it easy to avoid addressing deeper issues. Instead of focusing on whether children are reaching developmental milestones, staying out of the hospital, or succeeding in school, we focus on ensuring each patient visit is billed correctly. While RVUs and HEDIS metrics do have a place, they are limited measures of success. They don’t tell us whether children are thriving—they only tell us that services were delivered.

By resisting outcomes-based payment, we’re clinging to a model that prioritizes short-term revenue over long-term impact. Are we willing to accept that our focus on RVUs and HEDIS metrics might be keeping us from delivering the kind of care that truly matters?

Ignoring the Bigger Picture: Disturbing Trends in Pediatric Health

Look around, and you’ll see troubling trends in pediatric health that can no longer be ignored. Rates of mental health issues among children and adolescents have skyrocketed, yet many kids go undiagnosed and untreated because pediatric practices lack the resources for comprehensive mental health screenings. Obesity and other preventable chronic conditions are climbing, but our reimbursement models don’t reward providers for focusing on prevention.

Meanwhile, social determinants of health—like food insecurity, housing instability, and lack of access to early education—are driving poor outcomes for children in underserved communities. Yet, because these factors aren’t part of the typical pediatric “checklist,” they often go unaddressed in primary care.

If we continue to resist outcomes-based payment, are we not effectively ignoring these disturbing trends? We claim to be advocates for children’s health, but are we willing to tackle the factors that most affect it? Or is it easier to keep churning through appointments, knowing we’ll be paid as long as we code correctly and check the right boxes?

Why Are We Letting Investors Shape the Future of Pediatric Care?

An unsettling trend has emerged: more pediatric practices are being sold to private investors. With these acquisitions comes an increased focus on profitability. Investors demand efficiency, higher patient volumes, and quicker turnaround times. The pressure on providers to see more patients in less time is only intensifying.

When we resist outcomes-based and risk-based models, are we allowing investors to set the agenda for pediatric care? By sticking to a volume-based approach, we’re creating an environment where financial motives, rather than patient outcomes, drive decision-making. This shift raises serious ethical questions: should pediatric care be shaped by those who see children’s health as an investment opportunity?

Outcomes-based models, in contrast, could create incentives aligned with quality, collaboration, and preventive care. If we truly want to be advocates for children, shouldn’t we be questioning why we’re so quick to accept investor influence in pediatric care while resisting models that align with better patient outcomes?

Is Our Reluctance to Change Really About Losing Control?

There’s a certain autonomy that comes with the fee-for-service model. Providers have control over how they bill, and their income is tied to their productivity. Outcomes-based models, on the other hand, require collaboration, shared accountability, and alignment across multiple providers and services. This means working with school-based health services, telehealth providers, community organizations, and even urgent care centers.

Are we resisting because outcomes-based models require us to give up some of this control? Are we worried about “sharing” our patients with other providers or with systems that might monitor whether our interventions are truly making a difference? Or are we afraid that a focus on outcomes might reveal inefficiencies in our own practices?

The reality is that improving pediatric outcomes requires collective effort. No single pediatrician or practice can address all the complex needs that affect a child’s health. If we’re serious about improving outcomes, we’ll have to set aside some of the competition and territoriality that currently shape our approach to care.

What Would a Focus on Outcomes Actually Look Like?

It’s easy to point to the challenges of an outcomes-based model, but what would it look like if we embraced it? Here’s what a shift in focus might entail:

Collaborating with Community Resources: Rather than viewing school-based clinics, telehealth services, and urgent care as competitors, we could partner with them. Working together would create continuity of care, ensuring that children who receive services outside our offices remain part of a larger support network. Outcomes-based models would incentivize this kind of collaboration.

Addressing Social Determinants of Health: Pediatricians could routinely screen for food insecurity, housing instability, and other social factors, connecting families with resources instead of simply noting these issues. An outcomes-based system could reward practices that successfully address these social determinants, acknowledging that children’s health is shaped by their environment as much as by medical care.

Focusing on Preventive and Mental Health Care: Rather than waiting for problems to emerge, pediatricians could be rewarded for keeping children healthy and out of the hospital. Mental health screenings, obesity prevention, and developmental support would become priorities, with practices receiving financial incentives for meeting long-term wellness goals.

By focusing on these areas, we could start to turn around some of the most troubling trends in pediatric health. But this would require a cultural shift—a willingness to prioritize children’s health outcomes over our own comfort with the status quo.

The Real Question: Are We Ready to Rethink What Pediatric Care Should Be?

If we’re honest, much of the resistance to outcomes-based payment in pediatric care isn’t about what’s best for patients. It’s about the discomfort of change. It’s about losing control, losing volume-based revenue, and letting go of a system that has allowed us to measure success in narrow, short-term ways.

But the stakes are too high to continue on our current path. If we keep resisting outcomes-based models, we’re doubling down on a system that is failing too many children. We’ll keep seeing practices sold to private investors, a relentless focus on maximizing throughput, and too little emphasis on the things that truly make children healthier.

The future of pediatric care can either be a race for revenue or a coordinated, outcome-focused effort to give kids the best possible start in life. Are we willing to rethink our priorities? Are we prepared to embrace a model that challenges us but ultimately serves children better?

Outcomes-based care isn’t a threat—it’s an opportunity. It’s a chance to break free from the grind of RVUs, HEDIS metrics, and coding, and to focus on what truly matters. It’s a call to reclaim pediatric care from investors, from volume-driven models, and from outdated practices. But that will require us to be brave, to let go of what’s comfortable, and to build a system that truly serves the next generation.