Reimbursement

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For Community Oncology, Good News in PFS Offset by Potential Wreckage of MFP Proposal

July 15th 2025

CMS proposes the 2026 Physician Fee Schedule (PFS), addressing payment disparities in oncology, but the community oncology community warns of financial threats from the Inflation Reduction Act. Updates reflect late Tuesday release of the proposed 2026 schedule for the Hospital Outpatient Prospective Payment System.

Rise in drug pricing | Image Credit: Alex Puhovoy - stock.adobe.com
Medicare Inflation Rebates Show Limited Impact on Drug Price Trends

July 14th 2025

Image credit: Canva Illustration | Mary Caffrey
Practical Considerations for AI in Community Oncology

July 8th 2025

Image credit: Canva Illustration by Mary Caffrey
How AI Can Address the Troubled Business Model in Oncology

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

July 5th 2025

More News

What We’re Reading: Hospitals Charge Insurers More Than Medicare Rates; Recipient of Pig Kidney Transplant Dies; Mail-Ordered Abortion Pills Deemed Safe, Effective
May 14th 2024

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

AJMC Staff
A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.
Pills, thermometer, inhaler and money | Image credit: Sebastian - stock.adobe.com
May 10th 2024

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

Rose McNulty
Public hospitals were significantly more likely to sustain access to unprofitable services following 340B Drug Pricing Program participation, while nonprofit hospitals were mostly unaffected, according to a recent study.
Stethoscope on money | Image credit: utah51 - stock.adobe.com
May 6th 2024

Medicare Trust Fund Extends Solvency Another 5 Years

Laura Joszt, MA
The Medicare trust fund is now expected to deplete in 2036, with the Inflation Reduction Act being credited for at least some of the extension.
Health care costs | Image credit: Valeri Luzina - stock.adobe.com
May 3rd 2024

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

Rose McNulty
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

Rose McNulty
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

Rose McNulty
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.
AJMC EBO logo | Image credit : AJMC
April 15th 2024

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

Mary Caffrey Julia Bonavitacola
AJMC EBO logo | Image credit : AJMC
April 15th 2024

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

Joseph Alvarnas, MD
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April 11th 2024

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

Rose McNulty
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

Mary Caffrey
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

Mary Caffrey
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

Maggie L. Shaw
"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

Maggie L. Shaw
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

Rose McNulty
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.
COA logo | Image credit: COA
April 1st 2024

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

Mary Caffrey
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

Mary Caffrey
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

Rose McNulty
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

Mary Caffrey
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

AJMC Staff
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

Terry Wilcox
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

Mary Caffrey
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

AJMC Staff
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.
COA logo | Image credit: COA
February 27th 2024

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

AJMC Staff
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.
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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.
AJMC EBO logo | Image credit : AJMC
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.
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