Reimbursement

Latest News

Image credit: Canva Illustration | Mary Caffrey

Practical Considerations for AI in Community Oncology

By Mary Caffrey

July 8th 2025

Artificial intelligence (AI) transforms oncology by enhancing decision-making, improving patient care, and streamlining operations, while addressing challenges in data accuracy and equity, said speakers at the Tennessee Oncology “Tech Innovations in Community Oncology."

Image credit: Canva Illustration by Mary Caffrey

How AI Can Address the Troubled Business Model in Oncology

By Mary Caffrey

July 7th 2025

Blood sample lab | Image credit: Caris Life Sciences

At ASCO, Testing and AI Rival Drugs for Attention, but Reimbursement Remains a Barrier

By Mary Caffrey

July 5th 2025

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

By Mary Caffrey

June 30th 2025

Planned Parenthood | Image credit: William A. Morgan - stock.adobe.com

SCOTUS Rules Abortion Clinics Can Not Challenge South Carolina’s Medicaid Order

By Julia Bonavitacola

June 26th 2025

More News

Health care costs | Image credit: Valeri Luzina - stock.adobe.com

May 3rd 2024

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

Leaders at 49 accountable care organizations (ACOs) shared their perspectives on the Medicare Shared Savings Program, as well as a range of strategies for success and ongoing challenges.

Cash money stethoscope cost - adragan - stock.adobe.com

April 26th 2024

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

The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.

Dr Julie Patterson, National Pharmaceutical Council

April 24th 2024

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

Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council, spoke to the ways in which possible unintended effects of the Inflation Reduction Act of 2022 (IRA) could impact patients.

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.

Ben Jones, McKesson/Us Oncology

April 5th 2024

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

"The government really didn't rise to the challenge the way that it should have,” notes Ben Jones, vice president of government relations and public policy for The US Oncology Network. “Practices were in distress…stretching all resources to figure out workarounds."

Kathy Oubre, MS, Pontchartrain Cancer Center

April 5th 2024

Kathy Oubre on Navigating the Aftermath of the Change Healthcare Cyberattack

Kathy Oubre, MS, CEO of Pontchartrain Cancer Center, is 1 of 6 cochairs for the 2024 Community Oncology Conference, and here she discusses how meeting content has incorporated ongoing coverage of the extremely disruptive cyberattack and how there is still so much work to be done.

Julie Patterson, PharmD, PhD, National Pharmaceutical Council

April 3rd 2024

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

Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council, discussed potential impact of the Inflation Reduction Act of 2022 (IRA) on small molecule drug research and development investments toward subsequent indications.

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

Leslie Busby, MD, Rocky Mountain Cancer Centers

February 29th 2024

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

Hayden E. Klein Rose McNulty

Leslie Busby, MD, chairman of the US Oncology Network Pharmacy & Therapeutics Committee, discusses the process of developing patient-centered care plans within the framework of an accountable care organization (ACO) and the importance of staying up to date with the latest best practices and therapies.

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.

Dr Lucy Langer

February 1st 2024

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

Hayden E. Klein

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

<1 2 3 4 5 6 7 8

...

2 Commerce Drive
Suite 100
Cranbury, NJ 08512

© 2025 MJH Life Sciences^® and AJMC®.
All rights reserved.

Editorial Boards

Do Not Sell My Information

Terms & Conditions