Reimbursement

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NCCN Summit Seeks to Build Better Connections Between Oncology and Primary Care

May 7th 2025

The National Comprehensive Cancer Network (NCCN) policy summit highlighted the need for improved communication between oncology and primary care to enhance cancer survivor outcomes and care transitions.

Patient navigation | Image credit: AON
With Thyme Care Partnership, AON Achieves $6M in Savings in EOM’s First Performance Period

April 22nd 2025

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com
The IRA’s Unintended Consequences for Drug Pricing and Coverage

April 2nd 2025

Texas Oncology logo | Image: Texas Oncology
Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

March 18th 2025

Kirollos Hanna, PharmD
Embracing EOM, Enhancing Collaboration and Cost Management: Dr Kirollos Hanna

January 29th 2025

More News

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.
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.
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.
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.
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.
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