Pediatric vaccination bonuses are ~~stopping~~ shrinking. Pediatricians are going to have to do less with less. Until the next administration. >The metrics that once rewarded raw vaccine uptake as a proxy for care quality have been pulled from the federally mandated quality reporting framework. In doing so, CMS also issued a policy rebuke with weighty implications: it “strongly discourages” states from using immunization measures in payment arrangements. This statement, coming from the highest level of Medicaid policy, realigns the national posture on quality metrics and financial incentives.