They may be: Revenue stresses. S&P argues that, should even more pediatric commercial sufferers join insurance through exchanges, suppliers could start to discover smaller obligations from these brand-new guidelines than from traditional industrial contracts because of their services. In a few markets, contract discussions are receiving tougher, the survey indicates, and in claims where in fact the Medicaid applications are changing or where industrial insurance providers are more vigorous still, children’s clinics are performing pilot applications that place some reimbursement in danger for several quality and price metrics.