Reimbursement

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

March 18th 2025

Debra Patt, MD, PhD, MBA, executive vice president of Public Policy and Strategy for Texas Oncology, said the practice received positive feedback from nurses and patients during a pilot that concluded in February.

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

January 29th 2025

Class action book and gavel | Image credit: Zerbor – stock.adobe.com
GoodRx, PBMs Hit by Price Fixing Lawsuits

November 5th 2024

Screenshot of an interview with Stuart Staggs
The Challenge of Addressing Drug Spend to Drive Down Total Cost of Care in EOM

October 27th 2024

Stethoscope on money | Image credit: utah51 - adobe.stock.com
Pressure on Congress to Reform Medicare Physician Fee Schedule, Prevent Reimbursement Cuts

October 17th 2024

More News

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.
Kenneth Endo, MHA, BS, RTT | Image Credit: PIH Health Whittier Hospital
October 13th 2023

Oncology Financial Navigator Ensures Vital Care Access, Eases Economic Burden

Maggie L. Shaw
According to the National Cancer Institute, in the year following a cancer diagnosis, the average cost of medical care plus medication exceeds $42,000, with some treatments having a price tag of more than $1 million.
Health insurance concept using blocks with icons | Image credit: REDPIXEL - stock.adobe.com
October 7th 2023

Cigna to Pay $172M to Settle Claims of Wrongful Reimbursement by Medicare Advantage

Richard Payerchin
Cigna will pay $172 million to resolve allegations that it submitted inaccurate diagnosis codes for Medicare Advantage plan enrollees in order to increase payments from Medicare.
dr rajini katipamula-malisetti
October 6th 2023

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

Brooke McCormick
Rajini Katipamula-Malisetti, MD, executive vice president of Minnesota Oncology, defined value-based cancer care and its importance.
COA logo | Image credit: Community Oncology Alliance
October 6th 2023

COA: Inflation Cut Value of Medicare Payments by 28% Over Decade

AJMC Staff
The effects of flat or reduced reimbursements alongside inflation have been quantified in a report by Avalere Health, prepared for the Community Oncology Alliance (COA.)
rhonda henschel
October 3rd 2023

US Oncology Network’s Rhonda Henschel Discusses Value-Based Care, Payer Relations Initiatives

Brooke McCormick
Rhonda Henschel, US Oncology Network's vice president of payer relations, summarized what she learned from the Minnesota Oncology IVBM and discussed new developments in the value-based cancer care space.
Nicolas Ferreyros, Community Oncology Alliance
September 27th 2023

Collaboration Is Key to Success in Alternative Payment Models, Says COA’s Nick Ferreyros

Maggie L. Shaw
The number one ingredient that an oncology-based alternative payment model needs to succeed is collaboration, explained Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance (COA).
Headshot of Karen Kobelski, MBA
September 25th 2023

Contributor: MA Plans Can Leverage Advanced Technology to Shore Up Risk Adjustment Practices

Karen Kobelski, MBA
Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care for members.
Nick Ferreyros, Community Oncology Alliance
September 20th 2023

COA’s Nick Ferreyros Addresses Oncology Policy Changes and the IRA

Maggie L. Shaw
We are in the midst of a transformative time in oncology that could also be a little scary if you are not prepared, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.
Jackson Williams, JD | Image Credit: Dialysis Patient Citizens
September 17th 2023

Contributor: Medicare’s Leadership Needs to Confront Our Shrinking US Workforce

Jackson Williams, JD
Medicare’s administered pricing system has never had to deal with labor scarcity before.
Paper people chain
September 13th 2023

New CMMI Model Supports Health Equity in States, Shifts Care to the Community

Laura Joszt, MA
The AHEAD Model will operate for 11 years and aim to shift health care to community-based settings.
Andre Harvin, PharmD, MS, MBA, Cone Health Cancer Centers
September 10th 2023

Dr Andre Harvin: Specialty Pharmacists Are Integral to Oncology Care

Maggie L. Shaw
Specialty pharmacy is a big area of growth, with opportunity for patients, and specialty pharmacists can help payers and insurers ensure that patients get the full value of oncology medications, noted Andre Harvin, PharmD, MS, MBA, chief pharmacy officer, Oncology Services, Cone Health Cancer Centers.
G.B. John Mancini, MD, University of British Columbia
September 7th 2023

Dr G. B. John Mancini on Payer System Differences Between the US and Canada

Maggie L. Shaw
Care quality is high in both the United States and Canada, but there are commonalities in regard to drug access and cost issues, particularly with advanced medications, noted G. B. John Mancini, MD, University of British Columbia.
group of doctors
September 3rd 2023

MSSP ACOs Saved $1.8M in 2022, Report Sixth Consecutive Year of Savings

Laura Joszt, MA
The Medicare Shared Savings Program (MSSP) generated its second highest annual savings since the program began more than a decade ago.
patient with data points
August 30th 2023

Contributor: ACO Success—Driving Better Outcomes and Liberating Clinicians

Steven Reeves, MD, FACP
Physicians have been facing increasing workloads making it difficult to practice medicine as they were trained, but an accountable care organization might provide an opportunity for real change to deliver high-value, compassionate care.
Money and pills
August 29th 2023

CMS Releases List of 10 Drugs Subject to Price Negotiation Under IRA

Christina Mattina
The 10 drugs, spanning disease states from diabetes to heart failure to rheumatoid arthritis, cost Medicare enrollees a total of $3.4 billion in out-of-pocket costs in 2022. As required by the Inflation Reduction Act (IRA), negotiations between Part D and pharmaceutical companies will take place this year and next, with the negotiated prices taking effect in 2026.
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