Reimbursement

Latest News

May 14th 2024

What We’re Reading: Reimbursement Rate Disparities; Recipient of Pig Kidney Dies; Mail Order Abortion Pills Safe, Effective

By AJMC Staff

May 10th 2024

Public Hospitals More Likely to Extend Unprofitable Services After 340B Participation, Study Finds

By Rose McNulty

Medicare Trust Fund Extends Solvency Another 5 Years

By Laura Joszt, MA

Study: ACO Leaders Share Priorities, Challenges in Medicare Shared Savings Program

By Rose McNulty

April 26th 2024

CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues

By Rose McNulty

Video Interviews

April 24th 2024

How Potential Unintended Impacts of the IRA May Affect Patients: Dr Julie Patterson

April 5th 2024

The US Oncology Network's Ben Jones: Government Didn't "Rise to the Challenge" After Change Healthcare Cyberattack

April 5th 2024

Kathy Oubre on Navigating the Aftermath of the Change Healthcare Cyberattack

April 3rd 2024

Dr Julie Patterson Discusses Potential Unintended Effects of the IRA on Drug Development

February 29th 2024

Cancer Care Plans Within ACOs Must Center Patients First: Dr Leslie Busby

February 1st 2024

How UnitedHealthcare Incorporates Real-World Evidence Into Cancer Care Decision-Making, Policy Formulation

December 28th 2023

Dr Lalan Wilfong Highlights the Challenges of EOM Compared With OCM

December 21st 2023

COA’s Dr Miriam Atkins: APMs Can’t Be One Size Fits All

December 7th 2023

Ted Okon: Pressure Is Mounting on PBMs

October 6th 2023

Dr Rajini Katipamula-Malisetti: Minnesota Oncology Takes Value Very Seriously

Podcasts

March 26th 2024

Exploring Medicare Advantage Prior Authorization Variations

August 1st 2023

Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology

More News

April 15th 2024

In the PBM Wars, It’s the Consumers’ Day in Court

Mary Caffrey Julia Bonavitacola

April 15th 2024

Amid Rising Complaints About Prior Authorization Under Medicare Advantage, New Rule Leaves Gaps

Joseph Alvarnas, MD

Playbook for business | Image credit: vegefox.com - stock.adobe.com

April 11th 2024

AHIP, AMA, NAACOS Playbook Recommends Best Practices for Sustainable Value-Based Care

The new playbook details voluntary best practices for value-based care (VBC) payment arrangements and is part of an effort to increase VBC adoption in the private sector.

COA 2024 | Image credit: COA

April 6th 2024

Change Healthcare Could Get Congress’ Attention Before Break for Election

The annual legislative update at the Community Oncology Alliance Community Oncology Conference identified what Congress may focus on prior to the upcoming election.

Oncology Practices Keep Pace With PBMs, in Court and Beyond

April 5th 2024

Oncology Practices Keep Pace With PBMs, in Court and Beyond

This panel at the Community Oncology Alliance conference discussed the impact of pharmacy benefit manager (PBM) response to the end of direct and indirect remuneration fees, which has been dramatic cuts to cancer drug reimbursement.

April 1st 2024

COA 2024: Back in Orlando With Reimbursement Challenges Topping the Agenda

The annual Community Oncology Conference comes on the heels of a cyberattack that has caused significant disruption to providers, and many have sought relief from payers in areas such as prior authorization.

Kathy Oubre, MS | Image credit: LinkedIn

April 1st 2024

After Cyberattack, Oncology Practices Respond, Adapt Amid Calls for Reform

Hospital | Image credit: Spiroview Inc - stock.adobe.com

March 29th 2024

Health Equity Adjustments in Medicare HVBP Program Will Benefit Safety Net Hospitals, Study Says

Medicare’s upcoming health equity adjustment in the Hospital Value-Based Purchasing (HVBP) program will reduce disproportionate penalization among safety net hospitals and those serving high proportions of Black patients, according to a recent study.

Al Benson, MD

March 22nd 2024

Dr Al Benson on Reimbursement for Supportive Care When Treating Patients With Cancer

Hayden E. Klein Rose McNulty

Al Benson, MD, FACP, FACCC, FASCO, medical oncologist at Northwestern University Feinberg School of Medicine and associate director of the Robert E. Tillery Comprehensive Cancer Center, discussed findings from a national survey assessing barriers to comprehensive cancer care delivery.

AMA President Blasts Payers’ Response to Cyberattack

March 14th 2024

AMA President Blasts Payers’ Response to Cyberattack

As pressure from the Biden administration on UnitedHealth Group increases, physicians' groups weigh in following the unprecedented hack on Change Healthcare.

Pharmacist with patient | Image Credit: © Clayton D/peopleimages.com - stock.adobe.com

March 13th 2024

Fragmented Payer System, Vulnerable Supply Chain Among Threats to Accessing Essential Medicines

Christina Mattina

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

What We're Reading

March 13th 2024

What We’re Reading: 340B Contract Pharmacies; Nursing Home Ownership; Health Items in Proposed Budget

An appeals court rules against the Pharmaceutical Research and Manufacturers of America in a 340B contract pharmacy dispute; for-profit investors’ acquisition of nursing homes has raised concerns about the quality of care provided in these facilities; President Joe Biden’s proposed budget for 2025 includes changes that would do away with the current system of biosimilar interchangeability.

Where Have All the Doctors Gone? Medicare Physician Payment Cuts Threaten Patient Access to Quality Care

March 12th 2024

Where Have All the Doctors Gone? Medicare Physician Payment Cuts Threaten Patient Access to Quality Care

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

Biden Calls for Expanding Efforts to Control Drug Prices

March 8th 2024

Biden Calls for Expanding Efforts to Control Drug Prices

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

AJMC

March 6th 2024

Increased Medicare Payments for Homeless Patients Provide New Opportunities for Care

Jack Tsai, PhD, MSCP

A new federal rule will provide higher Medicare payments for homeless patients, which may encourage hospitals to identify these patients and help them with their needs.

What We’re Reading: Case for Cost Free Preventative Services; Medicare Pay Bump; MA Home Health Care Disparities

March 4th 2024

What We’re Reading: Case for Cost-Free Preventive Services; Medicare Pay Bump; MA Home Health Care Disparities

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access

February 27th 2024

COA Asks CMS to Resolve Express Scripts’ “Underwater” Payments Following End of DIR Fees

The Community Oncology Alliance (COA), which represents independent cancer care practices, has asked CMS to act following a dramatic drop in reimbursements from Express Scripts, Inc. effective January 1, 2024.

Business strategy | Image credit: WrightStudio - stock.adobe.com

February 23rd 2024

Kathy Oubre on Strategies to Mitigate Challenges When Adopting New Payment Models

Pearl Steinzor Rose McNulty

While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.

February 16th 2024

Rule Change for Patient Navigation Billing Is a Boon to Oncology Care, Practice Leaders Say

Julia Bonavitacola

Edward R. Arrowsmith, MD, MPH: Trust and Compromise Are Essential in Building Oncology Clinical Care Pathways

February 14th 2024

Edward R. Arrowsmith, MD, MPH: Trust and Compromise Are Essential in Building Oncology Clinical Care Pathways

Hayden E. Klein

From an interview conducted during Patient-Centered Oncology Care 2023.

Technology Helps Community Oncology Practices Implement PCM, CCM

February 14th 2024

Technology Helps Community Oncology Practices Implement PCM, CCM

Cameron Santoro

David A. Eagle, MD

February 12th 2024

Dr David Eagle: CMS Reimbursement Cuts Encourage Trend of Independent Physician Exodus

Giuliana Grossi

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019.

January 23rd 2024

Medicare Payment Rule Threatens Access to Life-Sustaining Kidney Care

John P. Butler Jennifer Payton, MHCA, BSN, RN, CNN

The authors call on Congress to reform Medicare reimbursement for dialysis, saying the recent rule puts clinics at risk of closure.

Christina Downey, MD | Image credit: American College of Rheumatology

January 8th 2024

To Preserve Access to Care, Congress Must Repair Medicare’s Broken Payment System

Christina Downey, MD

The author, chair of the Government Affairs Committee with the American College of Rheumatology, calls for support for efforts in Congress to reform the Physician Fee Schedule.

The Top 5 Reimbursement Content of 2023

December 31st 2023

Top 5 Most Popular Reimbursement Content of 2023

Laura Joszt, MA

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

Top 5 AJAC 2023

December 26th 2023

Top 5 Most-Read AJAC Articles of 2023

Christina Mattina

In 2023, the most-read articles published in The American Journal of Accountable Care® (AJAC) highlighted innovative care models, lessons learned from health system partnerships, and much more.

What’s the Early View of the EOM? Partners Offer Their Takes

December 23rd 2023

What’s the Early View of the EOM? Partners Offer Their Takes

Maggie L. Shaw Mary Caffrey

Top 5 AJMC Journal Articles of 2023

December 21st 2023

Top 5 Most-Read AJMC® Journal Articles of 2023

Christina Mattina

In 2023, the most-read articles published in the peer-reviewed The American Journal of Managed Care® (AJMC®) explored predictive models, opioid prescribing, and much more.

Implementing ePROs Is the Lift Worth Taking, Basch Says

December 21st 2023

Implementing ePROs Is the Lift Worth Taking, Basch Says

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

AJMC SAP seal

December 21st 2023

Paying for Cancer Care Differently: A Look Into the Future

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

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