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

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.
Kidney Care Partners logo | Image: LinkedIn
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.
Lalan Wilfong, MD, in an interview on blue AJMC background
December 28th 2023

Dr Lalan Wilfong Highlights the Challenges of EOM Compared With OCM

Maggie L. Shaw Laura Joszt, MA
While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.
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

Mary Caffrey
Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.
Miriam Atkins, MD, president of Community Oncology Alliance, during a video interview on blue AJMC background
December 21st 2023

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

Maggie L. Shaw Laura Joszt, MA
A one-size-fits-all approach to alternative payment models (APMs) often isn’t very fair to community practices, said Miriam Atkins, MD, FACP, president of the Community Oncology Alliance.
AJMC SAP seal
December 21st 2023

Paying for Cancer Care Differently: A Look Into the Future

Mary Caffrey
Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.
What We’re Reading: CMS Launches Maternal Health Model; Respiratory Disease Vaccines Initiative; Anti-Abortion Groups Move to Thwart Abortion Ballot Measures
December 18th 2023

What We’re Reading: CMS' Maternal Health Model; Respiratory Disease Vaccines Initiative; Attempts to Thwart Abortion Ballot Measures

AJMC Staff
Initiative aims to enhance maternal health and birth outcomes; Wegovy success will help fund a vaccines initiative for respiratory diseases; new tactics aim to remove abortion from the 2024 ballot
Highlights From NAMCP Spring Managed Care Forum 2023
December 16th 2023

ICYMI: Highlights From the NAMCP Spring Forum 2023

Laura Joszt, MA
Top coverage from the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023 included sessions on value-based care implementation and best treatment practices.
Stethoscope with health icons next to a white piggy bank | Image credit: Kiattisak - stock.adobe.com
December 15th 2023

Senate Introduces Bill to Extend 5% Incentives for APMs

Todd Shryock
The bipartisan bill would help lower Medicare costs and improve quality of care, according to the National Association of ACOs.
Ted Okon, MBA, of Community Oncology Alliance, during a Zoom video interview
December 7th 2023

Ted Okon: Pressure Is Mounting on PBMs

Maggie L. Shaw Laura Joszt, MA
Activity to regulate pharmacy benefit managers (PBMs) has started in the states and is trickling up to the federal level, said Ted Okon, MBA, executive director of the Community Oncology Alliance.
Pharmacist getting medication | Image credit: Karanov images - stock.adobe.com
December 5th 2023

CVS Announces More Transparent Model for Pharmacy Reimbursement, Drug Costs

Laura Joszt, MA
The company is changing the way it prices prescription drugs and providing more transparency, which has been one focus of pharmacy benefit manager regulation efforts.
Calculator and stethoscope on financial sheets | Image credit: Brian Jackson - stock.adobe.com.jpeg
December 1st 2023

Hospitals Report Declining Cash Reserves, Increasing Reimbursement Delays and Denials

Laura Joszt, MA
A new report highlighting the twin pressures hospitals have faced over the last 18 months shows that as reimbursement delays and denials increased and cash and investments decreased, operating expenses have risen sharply.
Stethoscope on money | Image credit: utah51 - stock.adobe.com
November 20th 2023

AMA Continues Call for Medicare Payment System Fix During Interim Meeting

Laura Joszt, MA
The American Medical Association (AMA) is continuing to urge Congress to stop the impending 3.4% cut to physicians, and other organizations also weigh in on the pros and cons of the 2024 Medicare Physician Fee Schedule.
what we're reading logo
November 15th 2023

What We’re Reading: UnitedHealth Lawsuit; Fentanyl Crackdown; Global Heat Deaths Increase

AJMC Staff
A class action lawsuit was filed against UnitedHealth Group and a subsidiary for allegedly using an algorithm to deny rehabilitation coverage for seriously ill patients; US and China officials are finalizing an agreement to crack down on fentanyl; a study published Tuesday projected global heat deaths to increase by 370% if no action is taken against global warming.
AJMC
November 8th 2023

All-Payer Value-Based Contracting in Organizations With Medicare ACOs

Robert E. Mechanic, MBA
This 2022 survey of Medicare accountable care organizations (ACOs) shows significant growth in non-Medicare value-based contracts and in contracts with downside risk.
Group of doctors talking
November 4th 2023

EOM Shows Awareness of Issues, but Provides No Resources, Says COA’s Nicolas Ferreyros

Laura Joszt, MA Maggie L. Shaw
The Enhancing Oncology Model is trying to address a number of the systemic challenges oncology faces without giving practices the tools and resources they need, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.
Impact of Including Drug Spending in Oncology Alternative Payment Models
November 3rd 2023

Impact of Including Drug Spending in Oncology Alternative Payment Models

Luca Maini, PhD Jacob P. Klimek, PhD David C. Johnson, MD, MPH George M. Holmes, PhD Darren A. DeWalt, MD, MPH
This study demonstrates a method for understanding the effects of drug spending in the design of alternative payment models.
Contributor: Preparing for Massive MTM Program Expansion—Pharmacy-Led Medical Cost Savings to Fund CMS Changes
November 3rd 2023

Contributor: Preparing for Massive MTM Program Expansion—Pharmacy-Led Medical Cost Savings to Fund CMS Changes

Jason Z. Rose, MHSA
Changes in the medication therapy management (MTM) program willl require planning on how to best fund this program in a way that drives medical cost savings.
stethoscope on money
November 2nd 2023

Congress Must Protect Physicians From Medicare Cuts: MGMA

Richard Payerchin
The Medical Group Management Association offers an analysis of pending legislation that could help health care practices better serve patients.
COA logo | image credit: COA
October 25th 2023

COA’s Policy Agenda Gains Steam on Capitol Hill, as the House Elects a Speaker

Mary Caffrey
There is bipartisan support in the Congress for the Community Oncology Alliance's (COA) key agenda items, with hope that some will pass by year’s end.
COA logo | image credit; COA
October 24th 2023

Confronting the Dynamics of Medicare Benefits When Those Eligible Are Still Working

Mary Caffrey
Community oncology practices are witnessing a new dynamic in which more Medicare-eligible patients are still covered by commercial insurance, according to speakers at the Community Oncology Alliance Payer Exchange Summit, held October 23-24, 2023.
EBO logo
October 20th 2023

The Challenges of Treating Cancer When the Patient Lives Far From Care

Peter Page
Christine Pfaff, RPh
October 17th 2023

Christine Pfaff on Ensuring Patient Access to Affordable Treatments

Laura Joszt, MA Maggie L. Shaw
To ensure patients are getting timely access to their treatments, there needs to be better collaboration between payers and providers, said Christine Pfaff, RPh, senior regional director of operations, American Oncology Network.
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